Evidence construction of Chinese herbal formulae for the treatment of H. pylori positive peptic ulcer: A Bayesian network Meta-analysis

Helicobacter pylori (H. pylori) positive peptic ulcer disease (PUD) is a highly prevalent digestive disease with serious consequences of poor prognosis without rational medical intervention. Apparent advantages of Chinese herbal formulae application in PUDs have been appreciated by clinical practitioners recently in China. However, there is no enough viewpoint of evidence-based medicine for them to reach a broad consensus at the more favorable formulae. Therefore, we adopted the method of Bayesian network Meta-analysis (BNMA) in order to get a solution. Literature retrieval of clinical randomized controlled trials (RCTs) was conducted with eight databases of PubMed, Embase, Cochrane Library, Web of Science, Chinese National Knowledge Infrastructure, the VIP medicine information system, the Wanfang Data Knowledge Service Platform and Chinese Biomedical Literature Service System. Review Manager 5.4 software, R project 4.1.1 software and STATA16.0 software were used to carry out this BNMA. The primary outcome indicator is H. pylori eradicated rate. The secondary outcome indicator is clinical effectiveness rate, recurrence rate and adverse reaction report. A total of fifty-one RCTs involving 5172 patients and ten therapeutic strategies were included in this BNMA. The results showed that supplementation with Chinese herbal formulae significantly improved the eradication rate, clinical efficiency and reduced recurrence rate of H. pylori compared with the single conventional triple therapy (CON) group in a relatively safe manner. Comprehensive therapeutic efficacy analysis of H. pylori eradicated rate and clinical effectiveness rate showed that CON combined with Xiangsha Liujunzi decoction (XSD) manifests at the first grade among these ten therapeutic strategies. The efficacy and safety of Chinese herbal formulae and conventional triple therapy were validated by this BNMA. CON+XSD appears to be the most satisfactory therapeutic strategy for H. pylori-positive PUD, reminding clinicians of the potential value of the combination of Chinese herbal formulae and conventional chemotherapy. https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42021268574.