Use of folic acid supplementation to halt and even reverse the progression of gastric precancerous conditions: a meta-analysis
What this study found
Overall, folic acid appeared to improve gastric precancerous pathology, especially gastric mucosal atrophy and intestinal metaplasia, with the clearest benefit seen at 20-30 mg/day for 3-6 months. Symptom relief was not statistically significant: RR 1.12 (95% CI 0.96-1.13, P=0.14; I2=63%). Recovery of gastric mucosal atrophy was significant in 5 studies: RR 1.61 (95% CI 1.07-2.41, P=0.02; I2=69%), and intestinal metaplasia improved in 2 trials: RR 1.77 (95% CI 1.32-2.37, P=0.0001; I2=0%). Ineffectiveness was reduced in 9 studies: RR 0.32 (95% CI 0.21-0.48, P<0.00001; I2=48%). The authors…
- Study & population
- Meta-analysis of 13 trials including 1252 participants with gastric precancerous conditions, mainly chronic atrophic gastritis, enrolled in China and diagnosed according to Chinese clinical guidelines.
- Intervention
- Folic acid supplementation was evaluated at 20-30 mg/day for 3-6 months, with daily oral dosing implied.
- Key limitation
- All included studies were conducted in China, which limits generalizability.
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Open PDFOriginal abstract
Background Current data indicate that supplements such as folic acid and vitamin B may be beneficial in halting and even reversing atrophic gastritis, intestinal metaplasia and intraepithelial neoplasia, generally referred to as gastric precancerous conditions(GPC). However, there is no Meta-analysis article to evaluate the prevention and treatment of folic acid in the gastric precancerous conditions. We therefore conducted a meta-analysis to confirm the efficacy of folic acid in treating GPC. Methods Using a systematic review method, consider randomized controlled trials (RCT), including clinical trial reports, unpublished clinical trial data, and conference papers. The search time was been set from the database’s establishment to June 2, 2021. The language was not limited, using PubMed, SinoMed, Lancet, Web of Science, CNKI, Cochrane, Ovid, Science Direct, Embase, and EBSCO databases. Data were extracted using a pre-designed extraction tool and analysis was undertaken using RevMan5.2.Besides,we use Origin software to construct the Time-dose interval analysis. Results Of the 225 records identified, 13 studies involving 1252 patients (including 11 clinical controlled trials, 1 conference paper report and 1 unpublished research report) met the inclusion conditions. Folic acid dose maintained at 20–30 mg / d for 3–6 months may be beneficial to pathological changes of GPC. Moreover, in the 3 month treatment of 5 trials, the effect was more obvious when the folic acid dose was maintained at 30 mg / d . In the 7 trials, the symptom ineffective rate of GPC treated with folic acid was 32% ( RR:0.32, 95% confidence interval CI:0.21–0.48), which was combined using a fixed analysis model; The effect of folic acid on gastric mucosal atrophy in 5 trials (RR: 1.61, 95%CI 1.07–2.41) . The changes of folic acid on intestinal metaplasia in the 2 experiments ( RR: 1.77, 95% CI: 1.32–2.37) .The 2 results are combined using a fixed analytical model. However, the subgroup analysis of 9 trials revealed no significant effectiveness of symptom. Conclusions Our research showed that folic acid supplementation brings benefits in preventing and even reversing the progression of GPC in the stomach, and provided evidence for its potential clinical use in management of GPC. Registration: The logn number of our Meta-anlysis on PROSPERO is CRD420223062.