Ursodeoxycholic acid for treatment of bile reflux gastritis: A systematic review

AIM: To systematically evaluate the efficacy of ursodeoxycholic acid(UDCA) in the treatment of bile reflux gastritis.METHODS: We searched PubMed, Cochrane Library, Chinese Academic Journal(CJFD), Chinese Biomedical Literature Database(CBM), Chinese Journal Full-Text Database(CNKI), Wanfang database, and VIP database(until December 2012)to collect randomized controlled trials(RCTs) that evaluated the efficacy of UDCA in the treatment of bile reflux gastritis. Other relevant journals were also searched manually. Literature screening, quality assessment and data extraction were conducted by two reviewers according to inclusion and exclusion criteria. Meta-analyses were conducted using RevMan 5.0.RESULTS: A total of 17 RCTs involving 1365patients were identified. According to the results of meta-analyses, trial groups was better than control groups in terms of overall efficacy(OR = 4.16, 95% CI: 2.68-6.46, P < 0.00001), rate of clinical symptom remission(OR = 4.99, 95%CI: 2.71-9.16, P < 0.00001) and cure rate(OR =1.92, 95% CI: 1.24-2.99, P = 0.004). In terms of improvement of mucosal inflammation revealed by gastroscopy, the UDCA + PPI + prokinetic drug group was better than the control group(OR = 4.45, 95% CI: 2.04-9.69, P = 0.0002), but the groups of UDCA + prokinetic drug + mucosal protective drug(P = 0.13) and UDCA + prokinetic drug(OR = 2.34, 95% CI: 0.78-6.98, P = 0.13)showed no significant difference compared to the control group. Six RCTs reported adverse effects and the UDCA group did not report adverse events.CONCLUSION: Our results show that UDCA is much more effective in the treatment of bile reflux gastritis than control drugs. However, there is a moderate risk of bias due to methodological quality problems in all 17 included RCTs.More strictly-designed, large-scale, high-quality,multi-centered RCTs are needed to confirm this result.