Abstract
BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSION: 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.