# Efficacy and safety of adjunctive Chinese herbal decoction in treating Helicobacter pylori–positive chronic atrophic gastritis: a real-world retrospective study

## TL;DR

A Chinese herbal formula improved treatment outcomes for a type of stomach inflammation linked to a common bacteria, showing better symptom relief and lower recurrence.

## Contribution

This study demonstrates the added benefit of Qingyoufang decoction in treating Helicobacter pylori–positive chronic atrophic gastritis in a real-world setting.

## Key findings

- Patients receiving Qingyoufang decoction had a significantly higher Helicobacter pylori eradication rate compared to standard therapy.
- The herbal formula was associated with better symptom improvement and lower recurrence rates over six months.
- Inflammatory cytokines showed a greater reduction trend in the Qingyoufang group in a small exploratory subgroup.

## Abstract

Chronic atrophic gastritis (CAG) associated with Helicobacter pylori (HP) infection is a common precancerous condition characterized by mucosal atrophy and gastrointestinal symptoms. Existing treatments show limited efficacy in symptom relief and are challenged by rising antibiotic resistance. Qingyoufang decoction (QYFD), a traditional Chinese herbal formula, is recommended for patients with spleen–stomach damp–heat syndrome (SSDHS), a common subtype of HP-positive CAG.

This real-world retrospective study enrolled 113 patients with HP-positive CAG and SSDHS from a single hospital between September 2021 and September 2024. Patients received either standard bismuth-containing quadruple therapy (n = 44) or the same regimen plus QYFD (n = 69) for 2 weeks. Clinical efficacy was evaluated through HP eradication rates, SSDHS symptom scores, serum inflammatory markers (interleukin-6 [IL-6], interleukin-6 [IL-8], and tumor necrosis factor-alpha [TNF-α]), and 6-month symptom recurrence. Kaplan–Meier analysis and Cox regression analysis were used to assess prognostic factors.

The HP eradication rate was significantly higher in the QYFD group than in the control group (92.75% vs. 79.55%, p = 0.038). The overall symptom improvement rate (cure + marked improvement + improvement) was also higher in the QYFD group (92.75%) than in the control group (79.55%, p = 0.033). In an exploratory subgroup analysis (n = 8 control, n = 13 QYFD), inflammatory cytokines (IL-6, IL-8, TNF-α) decreased in both groups, with a greater trend toward reduction in the QYFD group (p < 0.05 for all). The 6-month symptom recurrence rate was lower in the QYFD group (15.87% vs. 37.14%, p = 0.017). The Cox regression analysis identified alcohol consumption (HR = 8.681, 95% CI: 1.070–70.413, p = 0.043) and severe atrophy (HR = 26.536, 95% CI: 3.390–207.735, p = 0.002) as independent risk factors for recurrence, while QYFD treatment was a protective factor (HR = 0.318, 95% CI: 0.107–0.840, p = 0.038).

QYFD, as an adjunct to standard therapy, was associated with higher HP eradication rates, better symptom improvement, and lower symptom recurrence in patients with HP-positive CAG. A small exploratory subgroup suggested a potential reduction in inflammatory cytokines, which should be interpreted with caution. Further prospective studies are warranted to confirm these findings.