Efficacy and safety of oral Chinese patent medicine combined with quadruple therapy for chronic atrophic gastritis: a systematic review and network meta-analysis.

BACKGROUND: Chronic atrophic gastritis (CAG) is an important precancerous lesion of gastric cancer, with Helicobacter pylori (H. pylori) infection being a major etiological factor. Although quadruple therapy is the first-line treatment for H. pylori eradication, it still has certain limitations. The comparative efficacy of oral Chinese patent medicines combined with quadruple therapy remains unclear. Therefore, this study conducted a network meta-analysis (NMA) to systematically evaluate their efficacy and safety.

METHODS: Randomized controlled trials (RCTs) on oral Chinese patent medicines combined with quadruple therapy for chronic atrophic gastritis were searched electronically in databases including China National Knowledge Infrastructure (CNKI), VIP, WanFang, Chinese Biomedical Literature Database (CBM), PubMed, Web of Science, and Cochrane Library from January 1, 2016, to April 1, 2026. Network Meta-analysis was performed on the included RCTs using Stata and R software.

RESULTS: A total of 45 RCTs were included, involving 4,465 participants and 10 kinds of oral Chinese patent medicines. The network Meta-analysis showed that the 10 oral Chinese patent medicines (OCPMs) combined with quadruple therapy (QT) could effectively eradicate H. pylori eradication rates, improve gastrin and pepsinogen levels, and reduce inflammatory factor levels. The SUCRA ranking indicated that, Weisu granule combined with QT may be associated with greater benefit for improving H. pylori eradication rate, increasing motilin levels, and reducing interleukin-6 and tumor necrosis factor-α levels. Weifuchun tablets showed a favorable SUCRA ranking for increasing gastrin levels and reducing C-reactive protein and interleukin-8 levels. Moluo pills showed the highest SUCRA ranking for reducing interleukin-1β levels, while Jinghua Weikang Capsule showed the highest SUCRA probability for improving pepsinogen I levels. In addition, Biling Weitong granule ranked highest by SUCRA for improving pepsinogen II levels and the pepsinogen I/pepsinogen II ratio. However, these findings are based on indirect evidence and require confirmation in future head-to-head trials.

CONCLUSION: Within the limitations of low-certainty evidence, the 10 oral Chinese patent medicines combined with quadruple therapy showed exploratory trends in improving H. pylori eradication rates, gastrin, pepsinogen, and inflammatory factor levels in patients with chronic atrophic gastritis, with few adverse reactions. However, the evidence network was predominantly star-shaped without closed loops, lacking direct head-to-head comparisons among different patent medicines. Restricted by the small sample size, methodological flaws and high clinical heterogeneity of included trials, the current findings should be regarded as hypothesis-generating rather than definitive clinical conclusions. Further large-sample, multicenter, high-quality randomized controlled trials are still required to verify our exploratory results and support precise clinical decision-making.

SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261366962, CRD420261366962.