Published online May 27, 2023. doi: 10.4240/wjgs.v15.i5.871
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
Rikkunshito (TJ-43) relieves gastrointestinal disturbance by increases in the levels of acylated ghrelin.
To investigate the effects of TJ-43 in patients undergoing pancreatic surgery.
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.
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.
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.
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.