Effect of rikkunshito, a Japanese herbal medicine, on gastrointestinal symptoms and ghrelin levels in gastric cancer patients after gastrectomy.
BACKGROUND
Gastric cancer patients who undergo gastrectomy suffer from a post-gastrectomy syndrome that includes weight loss, dumping syndrome, reflux esophagitis, alkaline gastritis, and finally malnutrition. It is important to ameliorate the post-gastrectomy symptoms to restore postoperative quality of life (QoL). The aim of this study was to investigate the effect of rikkunshito, a Japanese herbal medicine, on postoperative symptoms and ghrelin levels in gastric cancer patients after gastrectomy.


METHODS
Twenty-five patients who had undergone gastrectomy received 2.5 g of rikkunshito before every meal for 4 weeks, and a drug withdrawal period was established for the next 4 weeks. Changes in gastrointestinal hormones, including ghrelin, and appetite visual analog scale scores were measured, and QoL was estimated by using the European Organization for Research and Treatment of Cancer core questionnaire QLQ-C30. The Dysfunction After Upper Gastrointestinal Surgery for Cancer (DAUGS) scoring system was used to evaluate gastrointestinal symptoms after gastrectomy.


RESULTS
Sixteen men and nine women (mean age 61.9 years) were enrolled in the study. All patients had either stage I (n = 24) or II (n = 1) disease and had undergone either distal gastrectomy (n = 17) or total gastrectomy (n = 8) by a laparoscopy-assisted approach. The mean ratio of the acyl-/total ghrelin concentration increased significantly after rikkunshito administration (Pre: 7.8 ± 2.1, 4 weeks: 10.5 ± 1.7 %, p = 0.0026). The total DAUGS score, as well as the scores reflecting limited activity due to decreased food consumption, reflux symptoms, dumping symptoms, and nausea and vomiting significantly improved after rikkunshito administration.


CONCLUSIONS
The present study demonstrated a significant attenuation of gastrointestinal symptoms after gastrectomy by treatment with rikkunshito. Rikkunshito is potentially useful to minimize gastrointestinal symptoms after gastrectomy.
Division of Gastroenterological Surgery, Department of Surgery, Graduate School of Medicine, Osaka University, 2-2, E2, Yamadaoka, Suita, Osaka, 565-0871, Japan. stakiguchi@gesurg.med.osaka-u.ac.jp
Shuji
S
Takiguchi
Yuichiro
Y
Hiura
Tsuyoshi
T
Takahashi
Yukinori
Y
Kurokawa
Makoto
M
Yamasaki
Kiyokazu
K
Nakajima
Hiroshi
H
Miyata
Masaki
M
Mori
Hiroshi
H
Hosoda
Kenji
K
Kangawa
Yuichiro
Y
Doki
D000368:Aged; D001066:Appetite / Q000187:drug effects; D004365:Drugs, Chinese Herbal / Q000627:therapeutic use*; D004377:Dumping Syndrome / Q000188:drug therapy; D004942:Esophagitis, Peptic / Q000188:drug therapy; D005260:Female; D054439:Ghrelin / Q000097:blood*; D006801:Humans; D007334:Insulin-Like Growth Factor I / Q000032:analysis; D020738:Leptin / Q000097:blood; D008297:Male; D008518:Medicine, East Asian Traditional; D008875:Middle Aged; D011178:Postgastrectomy Syndromes / Q000188:drug therapy*; D011788:Quality of Life; D013274:Stomach Neoplasms / Q000601:surgery*
D004365:Drugs, Chinese Herbal; D054439:Ghrelin; D020738:Leptin; C084136:liu-jun-zi-tang; D007334:Insulin-Like Growth Factor I