Rhubarb-based Chinese herbal formulae for hepatic encephalopathy: a systematic review and Meta-analysis

Ning Zhang, Shuangnan Zhou, Xiaohe Xiao, Zhen Wang, Yunfeng Bai, Tingting He, Chao Zhou, Yao Wang, Zhou Kun, Zhongxia Wang, Bing Liu, Larry J. Prokop, Matthew C. Hernandez, Jun Li, Man Gong

Research output: Contribution to journalReview article

Abstract

OBJECTIVE: To evaluate the effectiveness and safety of rhubarb-based Chinese herbal formulae (RCHF), which are widely used to treat hepatic encephalopathy (HE) in China. METHODS: Nine online databases were searched from inception to November 22, 2016. Eligible studies were randomized controlled trials of Traditional Chinese Medicine (TCM) treatment for adult patients (≥ 18 years old) with HE. Outcomes such as mortality rate, clinical response rate, blood ammonia level, and alanine aminotransferase were evaluated between TCM group and control group. RESULTS: Thirty studies involving 2661 HE patients were analyzed. Most studies used RCHF treatment. Compared with conventional treatment as usual, lactulose, and vinegar, RCHF were associated with significant improvement in clinical response rate [risk ratio (RR) = 1.33, 95% confidence interval (CI) = 1.25, 1.43, I2 = 0%; RR = 1.26, 95% CI = 1.14, 1.38, I2 = 22%; and RR = 1.19, 95% CI = 1.06, 1.33, I2= 0%, respectively] and significant reductions in levels of blood ammonia and alanine aminotransferase. Only minor RCHF-associated adverse events, such as abdominal pain (0.3%), anal tenesmus (0.3%), and diarrhea (2.3%), were reported, and there were no significant differences in these events between the treatment group and the three types of control group. CONCLUSION: The findings suggest that RCHF may be an alternative treatment option for HE patients. More rigorous multicenter studies with larger samples and longer observational periods are needed to confirm these findings.

Original languageEnglish (US)
Pages (from-to)721-734
Number of pages14
JournalJournal of Traditional Chinese Medicine
Volume37
Issue number6
StatePublished - Dec 15 2017

Fingerprint

Rheum
Hepatic Encephalopathy
Meta-Analysis
Odds Ratio
Chinese Traditional Medicine
Confidence Intervals
Alanine Transaminase
Ammonia
Lactulose
Therapeutics
Control Groups
Acetic Acid
Abdominal Pain
Multicenter Studies
Diarrhea
China
Randomized Controlled Trials
Databases
Safety
Mortality

Keywords

  • Drugs, Chinese herbal
  • Hepatic encephalopathy
  • Meta-analysis
  • Review
  • Rheum

ASJC Scopus subject areas

  • Complementary and alternative medicine

Cite this

Rhubarb-based Chinese herbal formulae for hepatic encephalopathy : a systematic review and Meta-analysis. / Zhang, Ning; Zhou, Shuangnan; Xiao, Xiaohe; Wang, Zhen; Bai, Yunfeng; He, Tingting; Zhou, Chao; Wang, Yao; Kun, Zhou; Wang, Zhongxia; Liu, Bing; Prokop, Larry J.; Hernandez, Matthew C.; Li, Jun; Gong, Man.

In: Journal of Traditional Chinese Medicine, Vol. 37, No. 6, 15.12.2017, p. 721-734.

Research output: Contribution to journalReview article

Zhang, N, Zhou, S, Xiao, X, Wang, Z, Bai, Y, He, T, Zhou, C, Wang, Y, Kun, Z, Wang, Z, Liu, B, Prokop, LJ, Hernandez, MC, Li, J & Gong, M 2017, 'Rhubarb-based Chinese herbal formulae for hepatic encephalopathy: a systematic review and Meta-analysis', Journal of Traditional Chinese Medicine, vol. 37, no. 6, pp. 721-734.
Zhang, Ning ; Zhou, Shuangnan ; Xiao, Xiaohe ; Wang, Zhen ; Bai, Yunfeng ; He, Tingting ; Zhou, Chao ; Wang, Yao ; Kun, Zhou ; Wang, Zhongxia ; Liu, Bing ; Prokop, Larry J. ; Hernandez, Matthew C. ; Li, Jun ; Gong, Man. / Rhubarb-based Chinese herbal formulae for hepatic encephalopathy : a systematic review and Meta-analysis. In: Journal of Traditional Chinese Medicine. 2017 ; Vol. 37, No. 6. pp. 721-734.
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title = "Rhubarb-based Chinese herbal formulae for hepatic encephalopathy: a systematic review and Meta-analysis",
abstract = "OBJECTIVE: To evaluate the effectiveness and safety of rhubarb-based Chinese herbal formulae (RCHF), which are widely used to treat hepatic encephalopathy (HE) in China. METHODS: Nine online databases were searched from inception to November 22, 2016. Eligible studies were randomized controlled trials of Traditional Chinese Medicine (TCM) treatment for adult patients (≥ 18 years old) with HE. Outcomes such as mortality rate, clinical response rate, blood ammonia level, and alanine aminotransferase were evaluated between TCM group and control group. RESULTS: Thirty studies involving 2661 HE patients were analyzed. Most studies used RCHF treatment. Compared with conventional treatment as usual, lactulose, and vinegar, RCHF were associated with significant improvement in clinical response rate [risk ratio (RR) = 1.33, 95{\%} confidence interval (CI) = 1.25, 1.43, I2 = 0{\%}; RR = 1.26, 95{\%} CI = 1.14, 1.38, I2 = 22{\%}; and RR = 1.19, 95{\%} CI = 1.06, 1.33, I2= 0{\%}, respectively] and significant reductions in levels of blood ammonia and alanine aminotransferase. Only minor RCHF-associated adverse events, such as abdominal pain (0.3{\%}), anal tenesmus (0.3{\%}), and diarrhea (2.3{\%}), were reported, and there were no significant differences in these events between the treatment group and the three types of control group. CONCLUSION: The findings suggest that RCHF may be an alternative treatment option for HE patients. More rigorous multicenter studies with larger samples and longer observational periods are needed to confirm these findings.",
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author = "Ning Zhang and Shuangnan Zhou and Xiaohe Xiao and Zhen Wang and Yunfeng Bai and Tingting He and Chao Zhou and Yao Wang and Zhou Kun and Zhongxia Wang and Bing Liu and Prokop, {Larry J.} and Hernandez, {Matthew C.} and Jun Li and Man Gong",
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T1 - Rhubarb-based Chinese herbal formulae for hepatic encephalopathy

T2 - a systematic review and Meta-analysis

AU - Zhang, Ning

AU - Zhou, Shuangnan

AU - Xiao, Xiaohe

AU - Wang, Zhen

AU - Bai, Yunfeng

AU - He, Tingting

AU - Zhou, Chao

AU - Wang, Yao

AU - Kun, Zhou

AU - Wang, Zhongxia

AU - Liu, Bing

AU - Prokop, Larry J.

AU - Hernandez, Matthew C.

AU - Li, Jun

AU - Gong, Man

PY - 2017/12/15

Y1 - 2017/12/15

N2 - OBJECTIVE: To evaluate the effectiveness and safety of rhubarb-based Chinese herbal formulae (RCHF), which are widely used to treat hepatic encephalopathy (HE) in China. METHODS: Nine online databases were searched from inception to November 22, 2016. Eligible studies were randomized controlled trials of Traditional Chinese Medicine (TCM) treatment for adult patients (≥ 18 years old) with HE. Outcomes such as mortality rate, clinical response rate, blood ammonia level, and alanine aminotransferase were evaluated between TCM group and control group. RESULTS: Thirty studies involving 2661 HE patients were analyzed. Most studies used RCHF treatment. Compared with conventional treatment as usual, lactulose, and vinegar, RCHF were associated with significant improvement in clinical response rate [risk ratio (RR) = 1.33, 95% confidence interval (CI) = 1.25, 1.43, I2 = 0%; RR = 1.26, 95% CI = 1.14, 1.38, I2 = 22%; and RR = 1.19, 95% CI = 1.06, 1.33, I2= 0%, respectively] and significant reductions in levels of blood ammonia and alanine aminotransferase. Only minor RCHF-associated adverse events, such as abdominal pain (0.3%), anal tenesmus (0.3%), and diarrhea (2.3%), were reported, and there were no significant differences in these events between the treatment group and the three types of control group. CONCLUSION: The findings suggest that RCHF may be an alternative treatment option for HE patients. More rigorous multicenter studies with larger samples and longer observational periods are needed to confirm these findings.

AB - OBJECTIVE: To evaluate the effectiveness and safety of rhubarb-based Chinese herbal formulae (RCHF), which are widely used to treat hepatic encephalopathy (HE) in China. METHODS: Nine online databases were searched from inception to November 22, 2016. Eligible studies were randomized controlled trials of Traditional Chinese Medicine (TCM) treatment for adult patients (≥ 18 years old) with HE. Outcomes such as mortality rate, clinical response rate, blood ammonia level, and alanine aminotransferase were evaluated between TCM group and control group. RESULTS: Thirty studies involving 2661 HE patients were analyzed. Most studies used RCHF treatment. Compared with conventional treatment as usual, lactulose, and vinegar, RCHF were associated with significant improvement in clinical response rate [risk ratio (RR) = 1.33, 95% confidence interval (CI) = 1.25, 1.43, I2 = 0%; RR = 1.26, 95% CI = 1.14, 1.38, I2 = 22%; and RR = 1.19, 95% CI = 1.06, 1.33, I2= 0%, respectively] and significant reductions in levels of blood ammonia and alanine aminotransferase. Only minor RCHF-associated adverse events, such as abdominal pain (0.3%), anal tenesmus (0.3%), and diarrhea (2.3%), were reported, and there were no significant differences in these events between the treatment group and the three types of control group. CONCLUSION: The findings suggest that RCHF may be an alternative treatment option for HE patients. More rigorous multicenter studies with larger samples and longer observational periods are needed to confirm these findings.

KW - Drugs, Chinese herbal

KW - Hepatic encephalopathy

KW - Meta-analysis

KW - Review

KW - Rheum

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AN - SCOPUS:85041475108

VL - 37

SP - 721

EP - 734

JO - Journal of Traditional Chinese Medicine

JF - Journal of Traditional Chinese Medicine

SN - 0255-2922

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