title: Involvement of herbal medicine as a cause of mesenteric phlebosclerosis: results from a large-scale nationwide survey.
abstract: BACKGROUND
  Mesenteric phlebosclerosis (MP) is a rare disease characterized by venous calcification extending from the colonic wall to the mesentery, with chronic ischemic changes from venous return impairment in the intestine. It is an idiopathic disease, but increasing attention has been paid to the potential involvement of herbal medicine, or Kampo, in its etiology. Until now, there were scattered case reports, but no large-scale studies have been conducted to unravel the clinical characteristics and etiology of the disease.
  
  
  METHODS
  A nationwide survey was conducted using questionnaires to assess possible etiology (particularly the involvement of herbal medicine), clinical manifestations, disease course, and treatment of MP.
  
  
  RESULTS
  Data from 222 patients were collected. Among the 169 patients (76.1 %), whose history of herbal medicine was obtained, 147 (87.0 %) used herbal medicines. The use of herbal medicines containing sanshishi (gardenia fruit, Gardenia jasminoides Ellis) was reported in 119 out of 147 patients (81.0 %). Therefore, the use of herbal medicine containing sanshishi was confirmed in 70.4 % of 169 patients whose history of herbal medicine was obtained. The duration of sanshishi use ranged from 3 to 51 years (mean 13.6 years). Patients who discontinued sanshishi showed a better outcome compared with those who continued it.
  
  
  CONCLUSIONS
  The use of herbal medicine containing sanshishi is associated with the etiology of MP. Although it may not be the causative factor, it is necessary for gastroenterologists to be aware of the potential risk of herbal medicine containing sanshishi for the development of MP.
authors.affiliation: Division of Gastroenterology and Hepatology, Osaka General Hospital of West Japan Railway Company, 5-9-1 Shirokane, Minato, Tokyo, 108-8642, Japan.
authors.forename: Seiji
authors.initials: S
authors.lastname: Shimizu
authors.affiliation: Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan.
authors.forename: Taku
authors.initials: T
authors.lastname: Kobayashi
authors.affiliation: Division of Gastroenterology and Hepatology, Osaka General Hospital of West Japan Railway Company, 5-9-1 Shirokane, Minato, Tokyo, 108-8642, Japan.
authors.forename: Hideo
authors.initials: H
authors.lastname: Tomioka
authors.affiliation: Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
authors.forename: Kensei
authors.initials: K
authors.lastname: Ohtsu
authors.affiliation: Department of Gastroenterology, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Matsui
authors.affiliation: Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan. thibi@insti.kitasato-u.ac.jp.
authors.forename: Toshifumi
authors.initials: T
authors.lastname: Hibi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004363:Drug Utilization / Q000706:statistics & numerical data; D004365:Drugs, Chinese Herbal / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D032062:Gardenia; D006306:Health Surveys; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D020835:Medicine, Kampo / Q000009:adverse effects; D008642:Mesenteric Veins / Q000000981:diagnostic imaging*; D008875:Middle Aged; D008517:Phytotherapy / Q000009:adverse effects*; D011859:Radiography; D012189:Retrospective Studies; D012598:Sclerosis; D014057:Tomography, X-Ray Computed; D061205:Vascular Calcification / Q000139:chemically induced* / Q000000981:diagnostic imaging / Q000453:epidemiology
chemical_list: D004365:Drugs, Chinese Herbal
keywords: Colorectal diseases; Colorectal pathology; Drug toxicity; Inflammatory bowel disease