Herbal and natural products as adjuncts to PPI-containing therapy: systematic review and meta-analysis
Adding herbal or natural product interventions to PPI-containing regimens increased H. pylori eradication rates by 20% (RR 1.20; 95% CI 1.14–1.27) across 18 studies involving 1984 participants.
Context
PPI-containing regimens, particularly bismuth quadruple therapy, disrupt gut microbiota through acid suppression, antibiotics, and bismuth exposure. Herbal adjuncts have been proposed to mitigate these perturbations, but systematic clinical evidence was lacking.
What the study showed
Meta-analysis showed a pooled RR of 1.20 (95% CI 1.14–1.27; I²=33%) for H. pylori eradication and RR of 1.19 (95% CI 1.14–1.25; I²=0%) for the Chinese-style 'total effective rate'. Exploratory microbiome analyses suggested higher post-treatment Bifidobacterium abundance in herbal groups. The 'total effective rate' is a non-standardized composite outcome and warrants cautious interpretation.
How it was done
Systematic review and meta-analysis across six databases (inception to March 2026); 17 RCTs and 1 observational study; n=1984 participants; risk of bias assessed with RoB 2.0 and ROBINS-I; prospectively registered in PROSPERO.
Limitations
Heterogeneity of herbal interventions across studies limits generalizability; inclusion of one observational study and a non-standardized composite outcome weakens overall conclusions. Assessment is based solely on the abstract without access to the full text.
In clinical practice
The eradication benefit is statistically significant but modest in magnitude; clinical adoption requires identification of the specific herbal product, dose, and target population, given the heterogeneous pool of interventions analyzed.