[Traditional Chinese medicine for ulcerative colitis: systematic reviews based on PRIO-harms]

This article is aimed to reevaluate the systematic reviews(Meta-analysis) of traditional Chinese medicine in the treatment of ulcerative colitis, and provide reference for evidence-based decision-making of traditional Chinese medicine(TCM). According to the preferred reporting items for overviews(preferred reporting items for overview of systematic reviews, PRIO-harms), the main Chinese and English electronic literature databases(PubMed, Cochrane Library, EMbase, CNKI, CBM, etc.) were retrieved, supplemented by manual retrieval. Systematic reviews for the treatment of ulcerative colitis with Chinese medicine up to February 2019 were included. Two researchers independently performed literature screening and data extraction. The methodology quality, reporting quality and evidence quality of the literature were evaluated by AMSTAR 2 tool, PRISMA scale and GRADE system respectively. Subgroup analysis was performed by using RevMan 5.3 software. A total of 21 systematic reviews were included, and the interventions mainly included TCM internal and external treatment, with 53 outcome indicators. The AMSTAR 2 results showed that 5 articles were of high quality, 9 of medium quality, 4 of low quality, and 3 of extremely low quality. The most problematic items were as follows: the list of excluded documents was not provided; the sources of funding for each study were not reported; and the research methods were not determined before implementation. PRISMA scale had an average score of(20.38±1.43) points, less than 22 points for 15 articles, with certain reporting defects. The GRADE system suggested that the quality of the evidence for the 30 outcome indicators was low or very low. The most important factors leading to degrading was the limitation, followed by publication bias and inconsistency. The results showed that as compared with conventional Western medicine, TCM oral or enema treatment for mild to moderate ulcerative colitis had better clinical efficacy and safety. Due to the quality limitations of the included studies, it is necessary to further strengthen the top-level design and follow the scientific research paradigm to provide a higher level of evidence for the clinical evidence-based decision-making of TCM.