Effect of rikkunshito, a Japanese herbal medicine, on gastrointestinal symptoms and ghrelin levels in gastric cancer patients after gastrectomy

Abstract

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.

Role of Ghrelin in the Pathophysiology of Gastrointestinal Disease

“…Rikkunshito is a kampo herbal medicine for treatment of upper GI symptoms of patients with FD, gastroesophageal reflux disease, dyspeptic symptoms of post-GI surgery patients 80. Rikkunshito was proposed to potentiate the orexigenic action of ghrelin by various mechanisms 81.…”

Clinical application of ghrelin administration for gastric cancer patients undergoing gastrectomy

“…The most critical drawback is that they are currently only able to administer ghrelin intravenously. For long-term administration, another delivery system (e.g., subcutaneous injection or inhalation) should be developed [49]. Oral ghrelin analog, which is already in clinical trials, is a possible ghrelin substitute.…”

Beneficial Effects of Rikkunshito, a Japanese Kampo Medicine, on Gastrointestinal Dysfunction and Anorexia in Combination with Western Drug: A Systematic Review

“…Patients' body weight significantly increased after the treatment course, and, in a subgroup analysis of patients showing a GSRS score of ≥2 before treatment, the mean total GSRS score significantly improved after treatment because of significant improvements in the subscale scores for abdominal pain, acid reflux, diarrhea, and constipation. Significant attenuation of post-gastrectomy gastrointestinal symptoms and increase in the ratio of acyl-/total ghrelin concentration by rikkunshito treatment for 4 weeks were also reported by Takiguchi et al in 25 patients who had undergone distal gastrectomy or total gastrectomy [19]. Takahashi et al, in a crossover study, examined the clinical effects of rikkunshito in 11 patients who were to undergo pylorus-preserving gastrectomy for early gastric cancer [20].…”