The effects of rikkunshito on body weight loss after esophagectomy

• Published in: The Journal of surgical research 2016-07, Vol.204 (1), p.130-138
• Main Authors: Nakamura, Masaki, MD, Nakamori, Mikihito, MD, Ojima, Toshiyasu, MD, Katsuda, Masahiro, MD, Hayata, Keiji, MD, Iwahashi, Makoto, MD, Yamaue, Hiroki, MD
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biomarkers - blood; Drug Administration Schedule; Drugs, Chinese Herbal - pharmacology; Drugs, Chinese Herbal - therapeutic use; Esophageal cancer; Esophageal Neoplasms - surgery; Esophagectomy; Female; Gastrointestinal Agents - pharmacology; Gastrointestinal Agents - therapeutic use; Ghrelin; Ghrelin - blood; Humans; Japanese herbal medicine; Male; Malnutrition - blood; Malnutrition - etiology; Malnutrition - prevention & control; Middle Aged; Postoperative Complications - blood; Postoperative Complications - prevention & control; Prospective Studies; Rikkunshito; Surgery; Treatment Outcome; Weight Loss - drug effects
• ISSN: 0022-4804; 1095-8673
• DOI: 10.1016/j.jss.2016.04.004

Abstract Background 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. Methods 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. Results 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). Conclusions For esophageal cancer patients after esophagectomy, rikkunshito is useful for improving body weight loss in connection with an increase in plasma acyl ghrelin levels.