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Life sciences · Review
Oncology Reviews · October 19, 2026
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Background Chronic atrophic gastritis and gastric precancerous lesions are associated with increased gastric cancer risk. Chinese herbal medicine is widely used as an adjunct to conventional therapy, but the certainty and clinical interpretation of its effects remain unclear. Objective To evaluate the efficacy and safety of Chinese herbal medicine added to the same conventional therapy for chronic atrophic gastritis and gastric precancerous lesions. Methods Eight international and Chinese databases and three trial registries were searched from inception to 31 March 2026 and updated to 16 August 2026. Randomised controlled trials comparing Chinese herbal medicine plus the same conventional therapy with conventional therapy alone and reporting extractable pathological outcomes were included. Random-effects models used restricted maximum likelihood estimation and Hartung-Knapp inference. Additional sensitivity analyses examined clinically comparable histopathology, baseline balance based on auditable pretreatment data, and exclusion of high-risk-of-bias results. Risk of bias was assessed using RoB 2 and certainty using GRADE. Results Sixty-nine randomised trials comprising 6,983 participants in eligible comparisons were included. Exploratory Broad end-of-treatment analyses favoured combined treatment for gastric mucosal atrophy (30 studies; SMD −1.63, 95% CI −2.03 to −1.24), intestinal metaplasia (29 studies; SMD −1.48, 95% CI −1.90 to −1.06), and dysplasia or intraepithelial neoplasia (21 studies; SMD −1.25, 95% CI −1.51 to −0.99). Heterogeneity was substantial (I 2 82.4%–92.7%); prediction intervals crossed the null for atrophy and intestinal metaplasia but not for dysplasia/intraepithelial neoplasia. Sensitivity analyses restricted to clinically comparable histopathological assessments included only three to four studies and were imprecise, with confidence intervals crossing the null. Helicobacter pylori clearance/negative conversion among baseline-positive participants was higher with combined treatment (15 studies; RR 1.25, 95% CI 1.15–1.37), whereas the strict test-of-cure sensitivity was imprecise (3 studies; RR 1.19, 95% CI 0.91–1.56). There was no clear evidence of a difference in reported adverse events (14-study evidence set; RR-contributing studies = 12; RR 0.93, 95% CI 0.58–1.50), which should not be interpreted as evidence of equivalent safety. Certainty was low for all five principal outcomes. Conclusion Chinese herbal medicine added to conventional therapy may be associated with lower short-term pathological scores on average, but the magnitude and clinical meaning of these effects remain uncertain because of trial limitations, marked heterogeneity, and imprecision in clinically comparable analyses. The findings do not establish durable histological regression or gastric cancer prevention, and the pooled estimates should not be interpreted as a class-wide effect applicable to all Chinese herbal medicines. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420261442138, identifier CRD420261442138.