Effects of rikkunshito, a kampo medicine, on quality of life after proximal gastrectomy.

BACKGROUND: The loss of the gastroesophageal junction after proximal gastrectomy (PG) induces various gastrointestinal symptoms, such as regurgitation, anorexia, and body weight loss, leading to impairment of the postoperative quality of life. In the present study, we investigated the long-term quality of life and the effects of rikkunshito, a traditional Japanese medicine (kampo), on the gastrointestinal symptoms and plasma ghrelin levels in patients with gastric cancer who had undergone PG. METHODS: Nineteen patients who had undergone PG> 6 mo before entry into the present study were enrolled. The plasma ghrelin levels, body weight, appetite, and Gastrointestinal Symptom Rating Scale (GSRS) scores were examined before and after the 4-wk administration of rikkunshito. A subgroup analysis was performed of patients showing a GSRS score of ≥ 2 before treatment, indicating the presence of gastrointestinal symptoms. RESULTS: The patients' body weight increased significantly after the administration of rikkunshito. Neither their appetite nor plasma acylated and deacylated ghrelin levels were significantly affected. In the subgroup analysis, the mean total GSRS score improved significantly from 2.6 ± 0.6 before the administration of rikkunshito to 1.9 ± 0.7 after administration because of the significant improvement in the subscale scores for abdominal pain, acid reflux, diarrhea, and constipation. CONCLUSIONS: The long-term quality of life was well preserved in the patients who had undergone PG at our hospital. In the patients with a baseline GSRS score of ≥2, rikkunshito significantly improved the symptoms of postgastrectomy syndrome, and its effect was possibly independent of the plasma ghrelin levels.

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

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.

[Clinical practice guidelines for evaluation and treatment of osteoporosis associated to endocrine and nutritional conditions. Bone Metabolism Working Group of the Spanish Society of Endocrinology]. / Guías de práctica clínica para la evaluación y tratamiento de la osteoporosis asociada a enfermedades endocrinas y nutricionales. Grupo de Metabolismo Mineral de la Sociedad Espa˜nola deEndocrinología y Nutrición.

OBJECTIVE: To provide practical recommendations for evaluation and treatment of osteoporosis associated to endocrine diseases and nutritional conditions. PARTICIPANTS: Members of the Bone Metabolism Working Group of the Spanish Society of Endocrinology, a methodologist, and a documentalist. METHODS: Recommendations were formulated according to the GRADE system (Grading of Recommendations, Assessment, Development, and Evaluation) to describe both the strength of recommendations and the quality of evidence. A systematic search was made in MEDLINE (Pubmed), using the following terms associated to the name of each condition: AND "osteoporosis", "fractures", "bone mineral density", and "treatment". Papers in English with publication date before 18 October 2011 were included. Current evidence for each disease was reviewed by two group members, and doubts related to the review process or development of recommendations were resolved by the methodologist. Finally, recommendations were discussed in a meeting of the Working Group. CONCLUSIONS: The document provides evidence-based practical recommendations for evaluation and management of endocrine and nutritional diseases associated to low bone mass or an increased risk of fracture. For each disease, the associated risk of low bone mass and fragility fractures is given, recommendations for bone mass assessment are provided, and treatment options that have shown to be effective for increasing bone mass and/or to decreasing fragility fractures are listed.

Bu ji (hozai) for treatment of postoperative gastric cancer patients.

We proposed that postgastrectomy cancer patients with organ deficit were xu zheng, or of deficient constitution, and administered bu ji or supplementary regimen to them. With alleviation of the symptoms, our diagnosis seemed correct from the traditional medicine perspective. Interleukin 2 reactivity, natural killer activity, nutritional index and bone mineral indices also improved. Such results suggest that our diagnosis was also correct according to Western medical theory. In addition, nutrition seemed to have positive relationship with NK activity and bone mineral content. Therefore, administration of bu ji seemed useful to improve the quality of life of postoperative cancer patients.

[Intestinal osteopathy following partial gastric resection]. / Intestinale Osteopathie nach Magenteilresektion.

26 years after a partial gastric resection (Billroth II) for recurrent gastric ulcer a 62-year-old man developed severe intestinal osteopathy. For three years he had increasing pain in the lower back and hip with a noticeable waddling gait. Serum concentration of calcium (2.0 mmol/l) and 25-hydroxy-vitamin D3 (38 mmol/l) were reduced, those of alkaline phosphatase (572 U/l) and parathormone (532 pg/ml) increased. Radiology demonstrated Looser's zones in the ribs and iliac crest. Osteodensitometry showed obviously diminished bone density. Iliac crest biopsy revealed signs of osteomalacia and secondary hyperparathyroidism. Within three months of starting oral vitamin D3 and calcium the symptoms had definitely receded and serum concentrations of calcium and alkaline phosphatase had become normal (2.4 mmol/l and 156 U/l, respectively). Osteopathic symptoms are often the expression of an abnormal calcium/phosphate metabolism. The cause often lies in the gastrointestinal tract; not rarely it is a late complication of a gastrojejunostomy.

Effect of acarbose, pectin, a combination of acarbose with pectin, and placebo on postprandial reactive hypoglycaemia after gastric surgery.

In a double-blind study we have compared the effect of 50 mg acarbose, 100 mg acarbose, 4.2 g pectin, a combination of 50 mg acarbose with 4.2 g pectin, and placebo on plasma glucose, plasma insulin, breath hydrogen and hypoglycaemic symptoms after a normal carbohydrate rich meal in nine patients with previous gastric surgery. Fifty milligrams acarbose, 100 mg acarbose and the combination of 50 mg acarbose with 4.2 g pectin significantly inhibited the postprandial peak glucose concentration (p less than 0.01). The lowest plasma glucose concentration, observed 60-150 minutes after ingestion of the meal, was significantly increased by the addition of 50 mg acarbose (p less than 0.01) and the combination of acarbose with pectin (p less than 0.05). The combination of acarbose with pectin was the only treatment that significantly inhibited the plasma insulin peak (p less than 0.05). Eight of nine patients had symptoms of hypoglycaemia on placebo, two on 50 mg acarbose (p less than 0.05), two on 100 mg acarbose (p less than 0.05), five on pectin (ns), and two on the combination of acarbose and pectin (p less than 0.05). All treatments with acarbose induced significant increases in breath hydrogen excretion (p less than 0.05).