OBJECTIVE To evaluate the efficacy and safety of Weiyan Tongluo Granules in treating chronic atrophic gastritis (CAG) and explore its potential mechanisms.

METHODS From June 2020 to December 2022, 100 CAG patients with spleen deficiency and blood stasis syndrome were enrolled and randomly divided into a trial group (n=50) and a control group (n=50) using a random number table. The trial group received Weiyan Tongluo Granules plus a folic acid placebo, while the control group received folic acid tablets plus a traditional Chinese medicine granule placebo. The treatment course for both groups was 24 weeks, with 8 and 10 dropouts in the trial and control groups, respectively. Post-treatment comparisons included OLGA/OLGIM staging reversal rates, low-grade intraepithelial neoplasia regression rate, SSDPRO-CG (Patient-Reported Outcome Scale for Chronic Gastritis in Spleen-Stomach Diseases) scores, TCM syndrome scores, and safety indicators. Serum levels of PG Ⅰ, PGⅡ, PGR, and G-17 were measured via ELISA before and after treatment. Gastric mucosal p-NF-κB and CDX2 protein expression levels were analyzed by Western blot, while mRNA levels of IL-1β, IL-6, VIL1, and MUC2 were quantified via qPCR.

RESULTS After treatment, the trial group showed significantly higher OLGA and OLGIM stage reversal rates than the control group (P < 0.05, P < 0.01), though no significant difference was observed in low-grade intraepithelial neoplasia regression. Both groups exhibited significant improvements in physiological domain scores and total SSDPRO-CG scores (P < 0.01), with the trial group outperforming the control group in physiological, independence, psychological domains, and total scores (P < 0.05, P < 0.01). TCM syndrome scores (total and sub-items: gastric distension, pain, poor appetite, bloating) decreased significantly in both groups (P < 0.01), while the trial group showed greater reductions in loose stools and dull complexion (P < 0.01). After-treatment, the trial group had significantly lower TCM syndrome scores than the control group (P < 0.05, P < 0.01). Serum PG Ⅰ, PGⅡ, PGR, G-17, gastric mucosal p-NF-κB, CDX2, and IL-1β, IL-6, VIL1, MUC2 mRNA levels improved significantly in the trial group (P < 0.05, P < 0.01), while the control group improved only in PGⅡ (P < 0.05, P < 0.01). The trial group's improvements in these biomarkers surpassed the control group's (P < 0.05, P < 0.01). No treatment-related adverse events occurred in either group.

CONCLUSION Weiyan Tongluo Granules ameliorate gastric mucosal pathology, clinical symptoms, psychological state, and quality of life in CAG patients without significant adverse effects. Its mechanism may involve suppressing the NF-κB pathway to reduce IL-1β and IL-6 expression, downregulating CDX2 to inhibit VIL1 and MUC2 transcription, thereby reversing the vicious cycle of inflammation-intestinal metaplasia.