title: The effects of rikkunshito on body weight loss after esophagectomy.
abstract: After esophagectomy, esophageal cancer patients suffer from malnutrition, anorexia, and dysfunction of digestion and absorption. Rikkunshito, a traditional Japanese herbal medicine, reportedly attenuates gastrointestinal symptoms and appetite loss after gastrointestinal surgery. We evaluated the clinical effect of rikkunshito and its relationship with ghrelin in esophageal cancer patients after esophagectomy.
  
  
  
  This prospective nonrandomized study included 40 patients with esophageal cancer who underwent esophagectomy at Wakayama Medical University Hospital. They were assigned to either the control group (n = 20, April 2011-January 2012) or the rikkunshito group (n = 20, January 2012-August 2012). Patients in the rikkunshito group received 2.5 g of rikkunshito before every meal for 48 wk beginning 4 wk after surgery. During the 48-week treatment, we assessed body weight loss, nutritional parameters, and quality of life (Functional Assessment of Cancer Therapy-Esophageal scale). The primary end point was the rate of body weight loss in two groups after the 48-week treatments.
  
  
  
  The rate of body weight loss was significantly less in the rikkunshito group than in the control group (P = 0.016). The acyl ghrelin level after the 48-week treatments was significantly higher in the rikkunshito group (131.7% ± 74.5%) than in the control group (75.6% ± 47.5%, P = 0.039). For the Functional Assessment of Cancer Therapy-Esophageal symptom scale, satisfaction of food consumption in the rikkunshito group was significantly better than in the control group at 52 wk postoperatively (P = 0.031).
  
  
  
  For esophageal cancer patients after esophagectomy, rikkunshito is useful for improving body weight loss in connection with an increase in plasma acyl ghrelin levels.
authors.affiliation: Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan.
authors.forename: Masaki
authors.initials: M
authors.lastname: Nakamura
authors.affiliation: Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan.
authors.forename: Mikihito
authors.initials: M
authors.lastname: Nakamori
authors.affiliation: Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan.
authors.forename: Toshiyasu
authors.initials: T
authors.lastname: Ojima
authors.affiliation: Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan.
authors.forename: Masahiro
authors.initials: M
authors.lastname: Katsuda
authors.affiliation: Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Hayata
authors.affiliation: Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Iwahashi
authors.affiliation: Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan. Electronic address: yamaue-h@wakayama-med.ac.jp.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Yamaue
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D004334:Drug Administration Schedule; D004365:Drugs, Chinese Herbal / Q000494:pharmacology* / Q000627:therapeutic use; D004938:Esophageal Neoplasms / Q000601:surgery*; D016629:Esophagectomy; D005260:Female; D005765:Gastrointestinal Agents / Q000494:pharmacology* / Q000627:therapeutic use; D054439:Ghrelin / Q000097:blood; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood / Q000517:prevention & control*; D011446:Prospective Studies; D016896:Treatment Outcome; D015431:Weight Loss / Q000187:drug effects*
chemical_list: D015415:Biomarkers; D004365:Drugs, Chinese Herbal; D005765:Gastrointestinal Agents; D054439:Ghrelin; C084136:liu-jun-zi-tang
keywords: Esophageal cancer; Esophagectomy; Ghrelin; Japanese herbal medicine; Rikkunshito