Gastrointestinal microbiota in treatment of gastric precancerous lesions and gastric cancer by Western and traditional Chinese medicine

Gastric precancerous lesions (GPL) represent a crucial stage in the complex process of gastric carcinogenesis that leads to gastric cancer (GC), one of the most prevalent cancers and a major source of cancer mortality worldwide. Many studies have identified the gastrointestinal microbiota, or gut microbiota, as an important contributor to both the pathogenesis and treatment of GPL and GC, thus understanding its role in this transition is crucial. The purpose of this literature review is to introduce the current landscape of microbiota research associated with GPL and GC, with an emphasis on Helicobacter pylori (H. pylori ) driven microbial dysbiosis and its modulation through Western medicine and traditional Chinese medicine (TCM) approaches. By elucidating the underlying mechanisms of H. pylori colonization, patterns, and interactions among microbiota, as well as the influence of microbial metabolites, this review highlights crucial driving factors of gastric carcinogenesis. The role of microbiota in conventional interventions, including H. pylori eradication, immunotherapy, as well as TCM herbal decoctions, is also discussed to provide a detailed understanding of the complex interactions between therapy and microbiota and how it could be potentially targeted for effective management of GPL and GC. Ultimately, microbiota-targeting therapeutics may represent a new path toward early detection, targeted treatment, improved prognosis, and potentially reduced incidence of GPL and GC.