Clinical Efficacy of Ursodeoxycholic Acid in Bile Reflux Gastritis: A Systematic Review and Meta-Analysis

Bile reflux gastritis (BRG) may lead to precancerous lesions of gastric cancer and gastric cancer. Although ursodeoxycholic acid (UDCA) has been used to treat BRG, its clinical efficacy remains unknown. Therefore, we systematically evaluated the efficacy and safety of UDCA compared with conventional therapy for BRG. We selected candidate studies and generated a forest plot to evaluate outcomes. Metaregression analysis was conducted to identify possible explanations for heterogeneity. Study quality was evaluated using the Cochrane Risk of Bias 2 tool and the Newcastle-Ottawa scale. The quality of evidence for the outcomes of the meta-analysis was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach. A total of 14 studies including 1605 patients were identified. Compared with control groups, medication combined with UDCA significantly reduced the number of reflux episodes [mean difference (MD) = - 17.99 times, 95% CI (- 19.84, - 16.14)], shortened the longest duration of reflux [MD = - 9.21 min, 95% CI (- 12.63, - 5.80)], decreased the number of long reflux episodes [MD = - 3.21 times, 95% CI (- 3.76, - 2.66)], increased the clinical response rate [risk ratio = 1.15, 95% CI (1.10, 1.19)], decreased the gastrin content [MD = - 18.03 ng/L, 95% CI (- 33.88, - 2.18)] and alleviated symptoms. UDCA demonstrates significant therapeutic efficacy for BRG, particularly with 8-week regimens, supporting its potential as a first-line therapy.