Retrospective Cohort Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Dec 6, 2021; 9(34): 10472-10483
Published online Dec 6, 2021. doi: 10.12998/wjcc.v9.i34.10472
Lamb’s tripe extract and vitamin B12 capsule plus celecoxib reverses intestinal metaplasia and atrophy: A retrospective cohort study
Si-Ran Wu, Jie Liu, Li-Feng Zhang, Na Wang, Lu-Yao Zhang, Qiong Wu, Jun-Ye Liu, Yong-Quan Shi
Si-Ran Wu, Jie Liu, Li-Feng Zhang, Na Wang, Lu-Yao Zhang, Yong-Quan Shi, State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases, Xijing Hospital, Air Force Military Medical University, Xi'an 710032, Shaanxi Province, China
Qiong Wu, Department of Clinical Nutrition, Xijing Hospital, Air Force Military Medical University, Xi'an 710032, Shaanxi Province, China
Jun-Ye Liu, Department of Radiation Protective Medicine, Air Force Military Medical University, Xi'an 710032, Shaanxi Province, China
Author contributions: Wu SR, Liu J, Shi YQ, Wu Q, and Liu JY designed the research; Wu SR, Liu J, Zhang LF, and Zhang LY made up the methodology; Liu J, Zhang LF, Zhang LY, and Wang N performed the research; Wu SR, Liu J, Zhang LY, and Wu Q managed the data; Liu J, Wu Q, Liu JY, and Wang N acquired the funding; Wu SR and Liu J finished the original draft; Shi YQ, Liu JY, and Wu Q reviewed and edited the paper.
Supported by Shaanxi Foundation for Innovation Team of Science and Technology, No. 2018TD-003; and Project from State Key Laboratory of Cancer Biology, No. 2019CBSKL2019ZZ07.
Institutional review board statement: This study was performed in accordance with the ethical principles for medical research as outlined in the Declaration of Helsinki. The study was approved by the institutional research ethics committee of the First Affiliated Hospital, the Air Force Medical University (KY20212048-C-1).
Informed consent statement: According to the approval of the institutional research ethics committee of the First Affiliated Hospital, the Air Force Medical University, this retrospective cohort study could be applied with exception to the requirement of informed consent forms or documents.
Conflict-of-interest statement: The authors declare that they have no conflict of interest to disclose.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yong-Quan Shi, MD, Chief Physician, Doctor, State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases, Xijing Hospital, Air Force Military Medical University, No. 127 Changle West Road, Xincheng District, Xi'an 710032, Shaanxi Province, China. shiyquan@fmmu.edu.cn
Received: March 27, 2021
Peer-review started: March 27, 2021
First decision: August 18, 2021
Revised: August 31, 2021
Accepted: October 24, 2021
Article in press: October 24, 2021
Published online: December 6, 2021
Processing time: 247 Days and 23.6 Hours
Abstract
BACKGROUND

Chronic atrophic gastritis (AG) with intestinal metaplasia (IM) significantly increases the risk of gastric cancer. Some medicines have showed definite therapeutic effects in AG and IM regression.

AIM

To validate the efficacy of Lamb’s tripe extract and vitamin B12 capsule (LTEVB12) initial therapy and celecoxib rescue therapy for IM and AG.

METHODS

A total of 255 patients were included to receive LTEVB12 initial therapy (2 capsules each time, three times daily for 6 mo) in hospital in this study. The patients with failure of IM regression continued to receive celecoxib rescue therapy (200 mg, once daily for 6 mo). After each therapy finished, the patients underwent endoscopy and biopsy examination. The regression efficiency was assessed by the operative link on gastritis assessment (OLGA) and the operative link on the gastric intestinal metaplasia assessment (OLGIM) staging system. Logistic regression analysis was applied to identify factors associated with the curative effect.

RESULTS

For LTEVB12 initial therapy, the reversal rates of IM and AG were 52.95% and 48.24%, respectively. Analogously, for celecoxib rescue therapy, the effective rates for IM and AG were 56.25% and 51.56%, respectively. The IM regression rate of complete therapy was up to 85.03%. In different OLGA and OLGIM stages of IM patients, therapeutic efficiency showed a significant difference in each group (P < 0.05). For both therapies, patients with high stages (III or IV) of both the OLGA and OLGIM evaluation systems showed a higher IM or AG regression rate than those with low stages (I or II). Among patients with high stages (OLGIM III and IV), the IM regression rate was above 70% for each therapy. Eating habits, fresh vegetable intake, and high-salt diet were identified as independent factors for the IM reversal effect of LTEVB12 therapy, especially high-salt diet (odds ratio = 1.852, P < 0.05).

CONCLUSION

Monotherapy could reverse IM and AG. LTEVB12 initial therapy and celecoxib rescue therapy significantly increase the regression effect. IM may not be the point of no return among gastric precancerous lesions.

Keywords: Atrophy gastritis; Intestinal metaplasia; Celecoxib; Stomach neoplasms; Operative link on the gastric intestinal metaplasia assessment; Operative link on the gastritis assessment

Core Tip: First, we used the operative link on the gastric intestinal metaplasia (IM) assessment and the operative link on the gastritis assessment staging systems to assess IM and atrophic gastritis regression of individual lesions. Monotherapy with either Lamb’s tripe extract and vitamin B12 capsule or celecoxib could reverse IM and AG. Additionally, the results proved that the integrative therapy combining Chinese and Western medicine had better regression effects. Last but not least, the results counter the argument that IM may not be the point of no return about gastric mucosal lesions.