Safety and efficacy of traditional herbal medicine Yukgunja-tang for atrophic gastritis: a systematic review and meta-analysis.

ETHNOPHARMACOLOGICAL RELEVANCE: Atrophic gastritis is a precancerous disease with limited treatment options. Yukgunja-tang (YT) has been widely used as an alternative medicine for gastric-related diseases; however, there is insufficient evidence of its efficacy in the treatment of atrophic gastritis.

AIM OF THE STUDY: To assess the efficacy and safety of YT alone and in combination with Western medicine (WM) for the treatment of atrophic gastritis.

METHODS

A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted. The Cochrane Risk of Bias Tool 2.0 was employed to evaluate the risk of bias. The level of evidence was assessed according to the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) System.

RESULTS

Meta-analysis of 22 RCTs (n = 2086) revealed that YT significantly improved total clinical efficacy rate (TCE) compared to WM alone, with low certainty of evidence. Combination therapy of YT and WM also showed a significantly higher TCE and symptom improvement efficacy rate compared to WM alone with moderate certainty. The combination of YT and WM was more effective in eradicating Helicobacter pylori with a notable increase in pepsinogen I and gastrin-17 levels. However, the certainty of the evidence was graded as low or very low. Fewer adverse events were reported in the YT groups compared to WM, indicating a favorable safety profile.

CONCLUSIONS

YT and an integrative treatment combining YT with WM may be more effective and safe than WM alone in the treatment of atrophic gastritis. However, high-quality, large-scale, and long-term trials in diverse regions are needed to confirm these findings.