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

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.