Chinese herbal medicine combined with conventional therapy for gastric precancerous lesions: a systematic review and meta-analysis
- 1Graduate School, Guangzhou University of Chinese Medicine , ,
- 2Graduate School, China Academy of Chinese Medical Sciences , ,
- 3Beijing University of Chinese Medicine Shenzhen Hospital (Longgang) (Shenzhen Longgang District Hospital of Traditional Chinese Medicine) , ,
Abstract
Background: Chronic atrophic gastritis and gastric precancerous lesions are associated with increased gastric cancer risk. Chinese herbal medicine is widely used as an adjunct to conventional therapy, but the certainty and clinical interpretation of its effects remain unclear.
Objective: To evaluate the efficacy and safety of Chinese herbal medicine added to the same conventional therapy for chronic atrophic gastritis and gastric precancerous lesions.
Methods: Eight international and Chinese databases and three trial registries were searched from inception to 31 March 2026 and updated to 16 August 2026. Randomised controlled trials comparing Chinese herbal medicine plus the same conventional therapy with conventional therapy alone and reporting extractable pathological outcomes were included. Random-effects models used restricted maximum likelihood estimation and Hartung-Knapp inference. Additional sensitivity analyses examined clinically comparable histopathology, baseline balance based on auditable pretreatment data, and exclusion of high-risk-of-bias results. Risk of bias was assessed using RoB 2 and certainty using GRADE.
Results: Sixty-nine randomised trials comprising 6,983 participants in eligible comparisons were included. Exploratory Broad end-of-treatment analyses favoured combined treatment for gastric mucosal atrophy (30 studies; SMD −1.63, 95% CI −2.03 to −1.24), intestinal metaplasia (29 studies; SMD −1.48, 95% CI −1.90 to −1.06), and dysplasia or intraepithelial neoplasia (21 studies; SMD −1.25, 95% CI −1.51 to −0.99). Heterogeneity was substantial (I2 82.4%–92.7%); prediction intervals crossed the null for atrophy and intestinal metaplasia but not for dysplasia/intraepithelial neoplasia. Sensitivity analyses restricted to clinically comparable histopathological assessments included only three to four studies and were imprecise, with confidence intervals crossing the null. Helicobacter pylori clearance/negative conversion among baseline-positive participants was higher with combined treatment (15 studies; RR 1.25, 95% CI 1.15–1.37), whereas the strict test-of-cure sensitivity was imprecise (3 studies; RR 1.19, 95% CI 0.91–1.56). There was no clear evidence of a difference in reported adverse events (14-study evidence set; RR-contributing studies = 12; RR 0.93, 95% CI 0.58–1.50), which should not be interpreted as evidence of equivalent safety. Certainty was low for all five principal outcomes.
Conclusion: Chinese herbal medicine added to conventional therapy may be associated with lower short-term pathological scores on average, but the magnitude and clinical meaning of these effects remain uncertain because of trial limitations, marked heterogeneity, and imprecision in clinically comparable analyses. The findings do not establish durable histological regression or gastric cancer prevention, and the pooled estimates should not be interpreted as a class-wide effect applicable to all Chinese herbal medicines.
Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261442138, identifier CRD420261442138.
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BibTeX
@article{feng2026chinese,
title = {{Chinese herbal medicine combined with conventional therapy for gastric precancerous lesions: a systematic review and meta-analysis}},
author = {Chang Feng and Jiamin Cao and Lu Zhan and Shujing Yi and Yuanqi Li and Fang Li and Run Yang and Yuantao Zhong and Xingen Jiang and Ruo Chen and Gaofei Feng},
journal = {Oncology reviews},
year = {2026},
month = oct,
doi = {10.3389/or.2026.1947905},
url = {https://europepmc.org/article/PMC/PMC13724460},
note = {CC BY},
}
RIS
TY - JOUR
TI - Chinese herbal medicine combined with conventional therapy for gastric precancerous lesions: a systematic review and meta-analysis
AU - Chang Feng
AU - Jiamin Cao
AU - Lu Zhan
AU - Shujing Yi
AU - Yuanqi Li
AU - Fang Li
AU - Run Yang
AU - Yuantao Zhong
AU - Xingen Jiang
AU - Ruo Chen
AU - Gaofei Feng
PY - 2026
DA - 2026/10/19
JO - Oncology reviews
DO - 10.3389/or.2026.1947905
UR - https://europepmc.org/article/PMC/PMC13724460
AB - Background: Chronic atrophic gastritis and gastric precancerous lesions are associated with increased gastric cancer risk. Chinese herbal medicine is widely used as an adjunct to conventional therapy, but the certainty and clinical interpretation of its effects remain unclear. Objective: To evaluate the efficacy and safety of Chinese herbal medicine added to the same conventional therapy for chronic atrophic gastritis and gastric precancerous lesions. Methods: Eight international and Chinese databases and three trial registries were searched from inception to 31 March 2026 and updated to 16 August 2026. Randomised controlled trials comparing Chinese herbal medicine plus the same conventional therapy with conventional therapy alone and reporting extractable pathological outcomes were included. Random-effects models used restricted maximum likelihood estimation and Hartung-Knapp inference. Additional sensitivity analyses examined clinically comparable histopathology, baseline balance based on auditable pretreatment data, and exclusion of high-risk-of-bias results. Risk of bias was assessed using RoB 2 and certainty using GRADE. Results: Sixty-nine randomised trials comprising 6,983 participants in eligible comparisons were included. Exploratory Broad end-of-treatment analyses favoured combined treatment for gastric mucosal atrophy (30 studies; SMD −1.63, 95% CI −2.03 to −1.24), intestinal metaplasia (29 studies; SMD −1.48, 95% CI −1.90 to −1.06), and dysplasia or intraepithelial neoplasia (21 studies; SMD −1.25, 95% CI −1.51 to −0.99). Heterogeneity was substantial (I2 82.4%–92.7%); prediction intervals crossed the null for atrophy and intestinal metaplasia but not for dysplasia/intraepithelial neoplasia. Sensitivity analyses restricted to clinically comparable histopathological assessments included only three to four studies and were imprecise, with confidence intervals crossing the null. Helicobacter pylori clearance/negative conversion among baseline-positive participants was higher with combined treatment (15 studies; RR 1.25, 95% CI 1.15–1.37), whereas the strict test-of-cure sensitivity was imprecise (3 studies; RR 1.19, 95% CI 0.91–1.56). There was no clear evidence of a difference in reported adverse events (14-study evidence set; RR-contributing studies = 12; RR 0.93, 95% CI 0.58–1.50), which should not be interpreted as evidence of equivalent safety. Certainty was low for all five principal outcomes. Conclusion: Chinese herbal medicine added to conventional therapy may be associated with lower short-term pathological scores on average, but the magnitude and clinical meaning of these effects remain uncertain because of trial limitations, marked heterogeneity, and imprecision in clinically comparable analyses. The findings do not establish durable histological regression or gastric cancer prevention, and the pooled estimates should not be interpreted as a class-wide effect applicable to all Chinese herbal medicines. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261442138, identifier CRD420261442138.
SN - 1970-5565
SN - 1970-5557
ER -