Xiao Chai Hu Tang for Peptic Ulcers: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

A peptic ulcer (PU) is a digestive disorder most commonly found in clinical practice. An oriental herbal formula, Xiao Chai Hu Tang (XCHT), has been used to treat PU for an extended period in China. The effectiveness and safety of XCHT in treating peptic ulcers was evaluated using a systematic review of randomized controlled trials (RCTs). Studies were systematically retrieved from CNKI, Embase, Medline, PubMed, SinoMed, VIP, Wanfang, and Web of Science. The following information was extracted from the relevant RCTs: the clinical efficacy rate, recurrence rate, clinical efficacy of traditional Chinese medicine, and the adverse effects. 13 RCTs, including 1334 patients, were included in this review. The meta-analysis showed that treatment with XCHT was superior to conventional pharmacotherapy (CPT) in improving the clinical efficacy rate (RR: 1.20, 95% confidence intervals (CIs): 1.08-1.34, P=0.0007), poor appetite (RR: 0.30, 95% CI: 0.15-0.61, P=0.0009), abdominal distension (RR: 0.61, 95% CI: 0.39-0.96, P=0.03), vomiting (RR: 0.33, 95% CI: 0.19-0.55, P < 0.0001), and stomach pain (RR: 0.36, 95% CI: 0.19-0.68, P=0.002) and reducing adverse events (RR: 0.23, 95% CI: 0.07-0.69, P=0.009). XCHT considerably increased the total clinical efficacy rate (RR: 1.22, 95% CI: 1.15-1.30, P < 0.00001) as both monotherapy and adjunctive therapy. The recurrence rate (RR = 0.29; 95% CI: 0.16-0.52, P < 0.0001) was remarkably decreased in the XCHT plus CPT group. The meta-analysis did not show a significant beneficial effect of XCHT compared with CPT in reducing the recurrence rate (RR = 0.45; 95% CI: 0.07-3.10, P=0.42) and acid reflux (RR: 0.76, 95% CI: 0.47-1.23, P=0.26). Our findings show that XCHT can treat peptic ulcers as part of an alternative medicine approach.