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Meta-Analysis
. 2021 Jan;36(1):64-74.
doi: 10.1111/jgh.15208. Epub 2020 Aug 17.

Effects of the herbal medicine Rikkunshito, for functional dyspepsia: A systematic review and meta-analysis

Seok-Jae Ko  1 , Jiseon Park  1 , Min-Ji Kim  1 , Jinsung Kim  1 , Jae-Woo Park  1
Affiliations
Meta-Analysis

Effects of the herbal medicine Rikkunshito, for functional dyspepsia: A systematic review and meta-analysis

Seok-Jae Ko et al. J Gastroenterol Hepatol. 2021 Jan.

Abstract

Background and aim: Functional dyspepsia (FD) is characterized by chronic and unexplained indigestion at upper abdomen. Because of unsatisfactory effect of conventional treatments, demand is growing for complementary and alternative medicine. Rikkunshito (RKT) is a herbal medicine, which has been widely used for FD in Asia; however, the evidence is lacking. We carried out systematic review and meta-analysis to evaluate the effect and safety of RKT in the treatment of FD.

Methods: Electronic databases were searched in April 2019, including PUBMED, EMBASE, and Cochrane Library. All eligible studies should be randomized controlled trials (RCTs) comparing RKT or combination therapy (RKT and western medicine) group to western medicine group. The primary outcome measure was the total clinical efficacy rate (TCE). The secondary outcomes were total dyspepsia symptom scale, gastric emptying rate, gastrin, motilin, recurrence 6 months after treatment, and Hamilton depression rating scale.

Results: Fifty-two RCTs with 5475 patients were involved in this systematic review and meta-analysis. Compared with western medicine, RKT showed significant better result, with higher TCE (relative risk = 1.21, 95% confidence interval 1.17 to 1.25, P < 0.001). RKT presented higher reduction of total dyspepsia symptom scale, more improved gastric emptying rate, and lower recurrence 6 months after treatment compared with western medicine. However, there was no significant difference in Hamilton depression rating scale between RKT and western medicine group. Combination therapy brought significant symptom improvement with TCE compared with western medicine alone.

Conclusions: Rikkunshito and combination therapy might be considered an effective alternative treatment for FD. Further rigorously designed and high-quality RCTs are needed.

Keywords: Functional dyspepsia; Meta-analysis; Rikkunshito; Systematic review; Western medicine.

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Figures

FIGURE 1
FIGURE 1
Preferred reporting items for systematic reviews and meta‐analyses chart of the selection process. CNKI, China National Knowledge Infrastructure Database; CiNii, Citation Information by National Institute of Informatics; AMED, Allied and Complementary Medicine Database; KISS, Korean Studies Information Service System; NDSL, National Digital Science Library; OASIS, Oriental Medicine Advanced Searching Integrated System.
FIGURE 2
FIGURE 2
Risk of bias assessment graph. formula image, Low risk of bias; formula image, Unclear risk of bias; formula image, High risk of bias. [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 3
FIGURE 3
Forest plot of TCE between RKT and western medicine group. TCE, Total clinical efficacy rate; RKT, Rikkunshito. [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 4
FIGURE 4
Forest plot of TCE between combination therapy (RKT and western medicine) and western medicine alone group. TCE, Total clinical efficacy rate; RKT, Rikkunshito. [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 5
FIGURE 5
Forest plot of TCE between XSRKT and domperidone, and TCE between combination therapy (XSRKT and domperidone) and domperidone alone group. XSRKT, Xiangsha Rikkunshito; TCE, Total clinical efficacy rate. [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 6
FIGURE 6
Funnel plot of TCE between RKT and western medicine group. TCE, Total clinical efficacy rate; RKT, Rikkunshito. formula image, RKT vs Domperidone; formula image, RKT vs Mosapride; formula image, RKT vs Prokinetics + Proton pump inhibitor. [Color figure can be viewed at wileyonlinelibrary.com]
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