Effectiveness and safety of traditional Chinese medicine decoction for diabetic gastroparesis:A network meta-analysis

BACKGROUND Diabetic gastroparesis(DGP)is a prevalent complication of diabetes that impairs people's quality of life and places a significant financial burden on them.The gastrointestinal symptoms of DGP patients can be improved by several Traditional Chinese Medicine(TCM)decoctions that have been shown to be effective in treating the disease.There are still many unanswered questions regarding the identification of appropriate therapeutic agents for the treatment of DGP in clinical practice.AIM To analyze the efficacy of several TCM decoctions in the treatment of DGP using Bayesian network meta-analysis for reference.METHODS PubMed,EMBASE,Cochrane Library,Web of Science,China National Knowledge Infrastructure,The China Biology Medicine DVD,Wanfang,and CQVIP were searched from inception to September 17,2022,to collect randomized controlled trials(RCTs)about TCM decoctions for DGP.Clinical effects and symptom scores were the primary outcomes.Additionally,we assessed motilin(MOT),somatostatin(SS),gastrin(GAS),gastric emptying rate,gastric emptying time,and adverse drug events as secondary outcomes.RESULTS A total of 67 eligible RCTs involving 4790 DGP patients and 7 TCM decoctions were included.The results of network meta-analysis(NMA)and surface under the cumulative ranking curve showed that with western medicine(WM)as a common control,the Banxia Xiexin Decoction(BXXD)+WM was most effective in clinical effects and enhancing early satiety scores;the Simo decoction(SMD)+WM was most effective in improving nausea and vomiting scores and anorexia scores,bloating scores;the Chaishao Liujunzi Decoction(CSLJD)was most effective in MOT,the Zhishi Xiaopi Decoction(ZSXPD)was most effective in SS and upgrading emptying rate;the Jianpi Xiaozhi Decoction was most effective in GAS;the CSLJD+WM was most effective in improving gastric emptying time.CONCLUSION These NMA results suggest that the BXXD+WM and SMD+WM may be one of the potential optimal treatments.Due to various limitations,further large-sample,double-blind,multi-center randomized RCTs are needed.

Combination of symptoms, syndrome and disease: Treatment of refractory diabetic gastroparesis

AIM:To assess effect of combination of symptoms,syndrome and disease on treatment of diabetic gastroparesis with severe nausea and vomiting.METHODS:Professor Tong Xiaolin’s clinical electronic medical records of patients who were treated between January 1,2006 and October 1,2012 were used as a database.Patients who met the inclusion criteria were enrolled.General information(name,sex and age),symptoms and blood glucose levels were obtained from the clinic electronic medical record,which was supplemented by a telephone interview.The patient-rated Gastroparesis Cardinal Symptom Index(GCSI)was used to evaluate the severity of the symptoms of gastroparesis.The effects of the treatment were assessed by the change in the severity of the symptoms of gastroparesis and the change in blood glucose between the baseline levels and the post-treatment levels at 1,2,4,8 and 12 wk.RESULTS:Forty-five patients had a mean GCSI nausea and vomiting severity score of 4.21±0.67 and a total GCSI score of 2.77±0.63 before treatment.There was a significant improvement in the nausea and vomiting score at every return visit compared with the baseline score(1 wk:3.02±1.04 vs 4.18±0.71,P<0.001;2wk:2.32±1.25 vs 4.16±0.73,P<0.001;4 wk:2.12±1.26 vs 4.12±0.73,P<0.001;8 wk:1.79±1.09vs 4.24±0.77,P<0.001;12 wk:0.69±0.92 vs 4.25±0.70,P<0.001).Twenty-five of the 45 patients had complete resolution of vomiting during the observation period(mean time to resolution was 37.9±27.3 d).The postprandial fullness and early satiety subscale,bloating subscale and total GCSI scores were also improved.Finally,the blood glucose levels improved after treatment,although the change was not significant.CONCLUSION:Use of the combination of symptoms,syndrome and disease to treat diabetic gastroparesis with refractory nausea and vomiting may be a new treatment option.

Xiangshaliujunzi Decoction for the treatment of diabetic gastroparesis: A systematic review

AIM:To assess the current clinical evidence of the effectiveness of Xiangshaliujunzi Decoction(XSLJZD)for the treatment of diabetic gastroparesis(DGP).METHODS:Randomized controlled trials(RCTs)were retrieved from seven major electronic databases including Medline,the Cochrane Library,Embase,Chinese Biomedical Literature Database(CBM),Chinese National Knowledge Infrastructure,Chinese Scientific Journal Database(VIP),and Wanfang Databases,using search dates from the beginning of the databases to May 2013.No language limitations were applied.We included RCTs that used XSLJZD or a modified XSLJZD compared with a control group for the treatment of DGP.The control groups included conventional treatment(Western medicinal treatment),placebo,and no treatment(blank),but not acupuncture.The main outcome index was clinical effectiveness,which was based on the gastric emptying test and variations in the gastrointestinal(GI)symptoms between the treatment and control groups after intervention.Data extraction,analysis,and quality assessment were conducted according to the Cochrane Handbook for Systematic Review of Interventions,Version 5.1.0.RESULTS:Ten RCTs involving 867 patients(441 in the experimental groups,and 426 in the control groups)were identified,and the overall methodological quality was evaluated as generally low.In the treatment groups,all 10 trials used herbs alone as the treatment,whereas all control groups used prokinetic medicine.The period of intervention ranged from 2 to 8 wk.Three classes were used to evaluate treatment efficacy:significant effective,effective,and ineffective,and all trials used the clinical effective rate(based on the gastric emptying test and changes in GI symptoms)to evaluate efficacy.The data showed that the effects of XSLJZD for the treatment of DGP were superior to the control group(n=867,RR=1.33,95%CI:1.24-1.42,Z=8.11,P<0.00001).Two trials recorded adverse events,and one trial reported follow-up.CONCLUSION:XSLJZD could restore the gastric emptying rate and improve symptoms.However,the evidence remains weak due to the poor methodological quality of the included studies.