The herbal medicine Rikkunshi-to stimulates and coordinates the gastric myoelectric activity in post-operative dyspeptic children after gastrointestinal surgery

Abstract

Rikkunshi-to (TJ-43), a gastroprotective herbal medicine, has been used for the symptomatic relief of adult patients with dyspepsia. However, its mechanism has yet to be fully elucidated. The aim of this study is to evaluate the effect of TJ-43 on the gastric myoelectric activity in post-operative dyspeptic patients, whose symptoms persisted for over 1 year after gastrointestinal surgery. Electrogastrography (EGG) recordings were performed to calculate the biomechanical parameters on the dominant peak frequency (DPF). Eight pediatric patients with dyspeptic symptoms after gastrointestinal surgery were examined and six age-matched children without any dyspeptic symptoms were used as controls, and they were compared with nine age-matched children without any dyspeptic symptoms after gastrointestinal surgery as subcontrols. All patients exhibited symptomatic relief after the administration of TJ-43, and the mean symptom score decreased significantly after the treatment of TJ-43 over a 1-month period ( P<0.0001). The variability index (VI) and the percentage of normal waves (PNW) were calculated as irregularity parameters of DPF. The power ratio (PR) was calculated as a parameter of the gastric contractile activity. There were no significant differences in the VI and PNW between the controls and patients during the postprandial state after therapy, even though significant differences existed regarding those parameters between the controls and patients before the therapy. There were no significant differences in the DPF, VI, and PNW between the controls and subcontrols. Furthermore, PR exhibited a significant increase after therapy ( P<0.05). However, there was a significant difference in the PR between the controls and subcontrols ( P<0.05). Postprandial dip was observed in all control subjects, eight patients in the subcontrols, and two patients after administration of TJ-43, respectively. An abnormal gastric electrical activity therefore seems to be an important factor in the pathophysiology of post-operative dyspeptic children. The coordinating and stimulating effect of TJ-43 on the gastric myoelectric activity therefore seems to play an important role in the reduction of dyspeptic symptoms.

Effects of Rikkunshi-to, a Traditional Japanese Medicine, on the Delay of Gastric Emptying Induced by NG-Nitro-L-arginine

“…Previously, the acceleration of gastric emptying (1, 10), the increase in plasma somatostatin and gastrin levels (11), and the stimulation of gastric myoelectric activity after gastrointestinal surgery (12) were reported as clinical effects of Rikkunshi-to. On the other hand, some basic studies have demonstrated that Rikkunshi-to prevents gastric mucosal damage (13,14) and recovers the gastric adaptive relaxation (GAR) abolished by treatment with L-NNA in the isolated guinea pig stomach (15).…”

Impaired ghrelin signaling is associated with gastrointestinal dysmotility in rats with gastroesophageal reflux disease

“…Clinically, it has been reported that rikkunshito improves gastrointestinal complaints related to functional dyspepsia (47,51), and its efficacy has been proven in a multicenter double-blind study (17). Recently, it has also been reported that rikkunshito leads to a fundamental and clinical reduction in esophageal acid reflux and related symptoms in patients with GERD (21)(22)(23)32).…”

Efficacy of Rikkunshito, a Traditional Japanese Medicine (Kampo), in Treating Functional Dyspepsia

“…Rikkunshito is an orally administered Japanese herbal (Kampo) preparation that is widely prescribed for patients showing various gastrointestinal symptoms such as gastroesophageal reflux (5,6), dyspeptic symptoms of post gastrointestinal surgery (7,8), and chemotherapy-induced nausea (9). Rikkunshito is composed of 8 constituents: Glycyrrhizae radix (4.7%), Zingiberis rhizoma (2.3%), Atractylodis lanceae rhizoma (18.6%), Zizyphi fructus (9.3%), Aurantii nobilis pericarpium (9.3%), Ginseng radix (18.6%), Pinelliae tuber (18.6%), and Hoelen (18.6%).…”