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. 2022 Aug 2;22(1):370.
doi: 10.1186/s12876-022-02390-y.

Use of folic acid supplementation to halt and even reverse the progression of gastric precancerous conditions: a meta-analysis

Jing Lei #  1 , Fugang Ren #  2 , Wenyuan Li #  3 , Xiaochuan Guo  4   5 , Qingsong Liu  1 , Hongjing Gao  1 , Yaobin Pang  1 , Yingjie He  1 , Jing Guo  6 , Jinhao Zeng  7   8
Affiliations

Use of folic acid supplementation to halt and even reverse the progression of gastric precancerous conditions: a meta-analysis

Jing Lei et al. BMC Gastroenterol. .

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Using a systematic review method, consider randomized controlled trials (RCT), including clinical trial reports, unpublished clinical trial data, and conference papers.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13 studies involving 1252 patients (including 11 clinical controlled trials, 1 conference paper report and 1 unpublished research report) met the inclusion conditions.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.

Keywords: Chronic atrophic gastritis; Dysplasia; Folic acid; Gastric cancer; Gastric precancerous conditions; Intestinal metaplasia; Meta-analysis; Precancerous lesions.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
PRISMA flow diagram for study selection
Fig. 2
Fig. 2
Risk of bias summary
Fig. 3
Fig. 3
Analysis of the effectiveness of folic acid for GPC symptom relief
Fig. 4
Fig. 4
analysis of ineffectiveness of folic acid for GPC symptom relief
Fig. 5
Fig. 5
Reversal of gastric mucosal atrophy
Fig. 6
Fig. 6
Intestinal metaplasia reversal
Fig. 7
Fig. 7
Time-dose interval analysis
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