Objectives. Conventional approaches for patients with nonerosive gastroesophageal reflux disease (NERD) were not satisfactory. This study aimed to evaluate the effectiveness and mechanisms of Chinese herbal medicine Hewei Jiangni Decoction (HWJND) as a novel and promising regimen for NERD. Methods. A total of 128 patients with NERD were randomly assigned to the Treatment group and Control group. The patients from the Treatment group were administered HWJND (81 g) plus dummy omeprazole (20 mg) daily for 8 weeks, and the others were given dummy HWJND granules (81 g) plus omeprazole (20 mg). The clinical efficacy was assessed using the gastroesophageal reflux disease questionnaire (GERD-Q) scale, patient reported outcomes (PRO) scale, and short form health survey 36 (SF-36) scale at week 4. Moreover, its pharmacological and molecular mechanisms were elucidated based on network pharmacology and molecular docking. Results. Due to case shedding and other reasons, 109 patients, including 56 in the Treatment group and 53 in the Control group completed this study. Our results showed that HWJND significantly improved heartburn, regurgitation, epigastric pain, nausea, and sleep disturbance, which led to a significant reduction of GERD-Q scores in NERD patients. In addition, PRO scores of NERD patients with HWJND administration were improved, and sufficient relief of physical role, body pain, general health, social function, and mental health on the SF-36 scale was also observed in patients after HWJND treatment. We further showed that the curative effect of HWJND was close to that of omeprazole, except for the better improvement of general health and social function. What’s more, the main active ingredients of HWJND included quercetin, beta-sitosterol, naringenin, baicalein, and kaempferol were retrieved, and the protective effects of HWJND against NERD may be closely related to targets such as TNF, IL6, IL1B, MMP9, CXCL8, and EGFR, which were mainly enriched in IL-17 signaling pathway and TNF signaling pathway. Conclusion. Our findings demonstrate that HWJND is noninferior to oral omeprazole for the treatment of patients with NERD, plays a therapeutic role through multiple targets and diverse pathways, and holds promise for complementary and alternative therapy for the treatment of NERD. This trial is registered with http://www.chictr.org.cn, Chinese Clinical Trials Registry [ChiCTR2200055960].

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Rationale: Gastric hyperplastic polyp (GHP) commonly arises in the abnormal background mucosa, which makes it easy to be misdiagnosed and missed, and has a potential risk of malignant transformation over time. Here, we present a case of neoplastic transformation of GHP in a context of autoimmune gastritis (AIG). Patient concerns: In 2020, a 67-year-old woman was admitted for endoscopic review 6 years after gastric polyp resection, the histological diagnosis of gastric polyp was neoplastic transformation of GHP as before. The patient had undergone multiple polypectomies at the same part. Then histological examination revealed that partial epithelial hyperplasia and dysplasia, and the neoplastic areas were interlaced with normal mucosa. Diagnoses and interventions: We further found that the background diagnosis was AIG. These results supported the diagnosis of neoplastic transformation of GHP in a context of AIG. With the doubt of missed diagnose, we retrospectively analyzed the medical history in 2014, 2015 and 2016, confirmed the presence of AIG. Unfortunately, serological tests and special treatment were not performed. Outcomes: The correct diagnosis was eventually confirmed in 2020, which enables patients to receive normal treatment and monitoring, and avoids further deterioration of the disease. Lessons: The purpose of this case report is to increase clinical awareness of neoplastic transformation of GHP in a context of AIG, and hope promise for early diagnosis and treatment.

Background: Gastric hyperplastic polyp commonly arises in the abnormal background mucosa, including autoimmune gastritis, also known as type A gastritis. There are no obvious clinical symptoms in the early stages of the disease, which makes it easy to be misdiagnosed and missed, and has a potential risk of malignant transformation over time.Case presentation: In 2020, a 67-year-old woman was admitted for review 6 years after gastric adenoma resection. Upper endoscopy revealed multiple lobulated polyps in the gastric body, which was histologically diagnosed as gastric adenomatous polyp as before. Interestingly, we discovered that the patient had undergone multiple polypectomies at the same part, which was inconsistent with the pathogenesis of adenomatous polyp. Then we did histological examination and revealed that partial epithelial hyperplasia and dysplasia, and the neoplastic areas were interlaced with normal mucosa. We further found that the background diagnosis was autoimmune gastritis. These results supported the diagnosis of neoplastic transformation of gastric hyperplastic polyp, not gastric adenomatous polyp. With the doubt of possible be misdiagnosed, we reviewed the medical history. Retrospective analysis in 2014, 2015 and 2016 confirmed the presence of autoimmune gastritis. Unfortunately, serological tests were not performed and no special treatment was done. Fortunately, the correct diagnosis was eventually confirmed as neoplastic transformation of gastric hyperplastic polyp in a context of autoimmune gastritis in 2020, which enables patients to receive normal treatment and monitoring, and avoids further deterioration of the disease. Conclusions: The purpose of this case report is to increase clinical awareness of neoplastic transformation of gastric hyperplastic polyp in a context of autoimmune gastritis, and hope promise for early diagnosis and treatment.