Rikkunshito increases appetite by enhancing gastrointestinal and incretin hormone levels in patients who underwent pylorus-preserving pancreaticoduodenectomy: A retrospective study

doi:10.4240/wjgs.v15.i5.871

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World Journal of Gastrointestinal Surgery

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Retrospective Study

World J Gastrointest Surg. May 27, 2023; 15(5): 871-881
Published online May 27, 2023. doi: 10.4240/wjgs.v15.i5.871

Rikkunshito increases appetite by enhancing gastrointestinal and incretin hormone levels in patients who underwent pylorus-preserving pancreaticoduodenectomy: A retrospective study

Hiroshi Kono, Naohiro Hosomura, Hidetake Amemiya, Katsutoshi Shoda, Shinji Furuya, Hidenori Akaike, Yoshihiko Kawaguchi, Hiromichi Kawaida, Daisuke Ichikawa

Hiroshi Kono, Naohiro Hosomura, Hidetake Amemiya, Katsutoshi Shoda, Shinji Furuya, Hidenori Akaike, Yoshihiko Kawaguchi, Hiromichi Kawaida, Daisuke Ichikawa, First Department of Surgery, University of Yamanashi, Chuo, Yamanashi 409-3898, Japan

Author contributions: Kono H conducted and organized this experiment; Hosomura N Amemiya H and Akaike H made an assessment of samples; Shoda K, Furuya S and Kawaguchi Y analyzed the data; Kawaida H collected the samples; Ichikawa D provided suggestions for this experiment.

Institutional review board statement: This study was approved by University of Yamanashi Hospital Institutional Review Board (Chief of the committee Zentaro Yamagata; and Approval number: 820) and was performed following the ethical standards outlined in the Declaration of Helsinki and its later amendments. Informed consent was obtained from all patients and/or donors of clinical samples, including blood or tissues, where necessary, at the time of admission.

Informed consent statement: All study participants, or their legal guardians, were provided informed written consent prior to study enrollment.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Data sharing statement: No additional data are available.

Corresponding author: Hiroshi Kono, MD, PhD, Associate Professor, First Department of Surgery, University of Yamanashi, 1110 Shimokato, Chuo, Yamanashi 409-3898, Japan. hkouno@yamanashi.ac.jp

Received: November 15, 2022
Peer-review started: November 15, 2022
First decision: February 15, 2023
Revised: February 22, 2023
Accepted: April 7, 2023
Article in press: April 7, 2023
Published online: May 27, 2023
Processing time: 191 Days and 23.1 Hours

Abstract

BACKGROUND

Rikkunshito (TJ-43) relieves gastrointestinal disturbance by increases in the levels of acylated ghrelin.

AIM

To investigate the effects of TJ-43 in patients undergoing pancreatic surgery.

METHODS

Forty-one patients undergoing pylorus-preserving pancreaticoduodenectomy (PpPD) were divided into two groups; patients took daily doses of TJ-43 after surgery or after postoperative day (POD) 21. The plasma levels of acylated and desacylated ghrelin, cholecystokinin (CCK), peptide YY (PYY), gastric inhibitory peptide (GIP), and active glucagon-like peptide (GLP)-1 were evaluated. Oral calorie intake was assessed at POD 21 in both groups. The primary endpoint of this study was the total food intake after PpPD.

RESULTS

The levels of acylated ghrelin were significantly greater in patients treated with TJ-43 than those in patients without TJ-43 administration at POD 21, and oral intake was significantly increased in patients treated with TJ-43. The CCK and PYY levels were significantly greater in patients treated with TJ-43 than those in patients without TJ-43 treatment. Furthermore, the GIP and active GLP-1 levels increased and values at POD 21 were significantly greater in patients treated with TJ-43 than those in patients without TJ-43 administration. Insulin secretion tended to increase in patients treated with TJ-43.

CONCLUSION

TJ-43 may have advantages for oral food intake in patients in the early phase after pancreatic surgery. Further investigation is needed to clarify the effects of TJ-43 on incretin hormones.

Keywords: Gastrointestinal hormone; Japanese traditional herbal medicine; Ghrelin; Incretin; Pancreatic surgery

Core Tip: This study investigated the effects of a Japanese herbal medicine, namely rikkunshito (TJ-43), on patients who underwent pancreatic surgery. TJ-43 may promote oral food intake in patients in the early phase after pancreatic surgery because TJ-43 increases appetite by enhancing gastrointestinal and incretin hormone levels.