Dietary Herb Extract Rikkunshi-To Ameliorates Gastroparesis in Parkinson's Disease: A Pilot Study

Doi, Hiroyuki; Sakakibara, Ryuji; Sato, Munehiko; Hirai, S; Masaka, Tohru; Kusumoto, Masahiko; Tsuyusaki, Yohei; Tateno, Akihiko; Tateno, Fuyuki; Takahashi, Osamu; Ogata, Tsuyoshi

doi:10.1159/000355608

Cited by 32 publications

(20 citation statements)

References 12 publications

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“…Our data also indicate that in 6-OHDA PD model, rikkunshito can normalize the delayed gastric emptying of a nutrient meal induced by LD/CD. This data may have translational application as in a recent pilot, open-label clinical study, rikkunshito was reported to ameliorate gastro-paresis in 20 PD patients of whom 16 were treated with LD/CD [14]. …”

Section: Discussionmentioning

confidence: 99%

“…Likewise, rikkunshito, a Japanese Kampo medicine acting as a ghrelin enhancer [50], alleviates gastroparesis [1,52], dyspepsia [1,25,52,54,61], post-operative gastric ileus [27,62], and gastroesophageal reflux disease [31,34,54] in experimental or clinical studies. A recent pilot clinical study also indicates that rikkunshito can ameliorate gastroparesis in PD patients [14]. …”

Section: Introductionmentioning

confidence: 99%

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Preventive effect of rikkunshito on gastric motor function inhibited by l-dopa in rats

et al. 2014

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We previously reported that ghrelin prevented l-dopa (LD)-induced inhibition of gastric emptying (GE) of a non-nutrient solution in rats. Parkinson’s disease treatment involves the combined administration of l-dopa with the enzyme l-amino acid decarboxylase inhibitor, carbidopa (CD) to reduce peripheral formation of dopamine. We investigated the effect LD/CD given orogastrically (og) on GE of a non-nutrient or nutrient meal and whether og pretreatment with rikkunshito, a kampo medicine clinically used to treat gastroparesis, influenced LD/CD effect on GE and postprandial antral and duodenal motility in conscious rats. LD/CD (20/2 mg kg−1) decreased significantly GE to 26.3 ± 6.0% compared to 61.2 ± 3.2% in og vehicle monitored 20-min after a non-nutrient meal and to 41.9 ± 5.8% compared to 72.9 ± 5.2% in og vehicle monitored 60 min after a nutrient meal. Rikkunshito (0.5 or 1.0 g kg−1) reduced the LD/CD (20/2 mg kg−1) inhibition of GE of non-nutrient meal (36.9 ± 7.4% and 46.6 ± 4.8% respectively vs. 12.1 ± 7.4% in og vehicle plus LD/CD) while having no effect alone (56.6 ± 8.5%). The ghrelin antagonist, [d-Lys3]-GHRP-6 (1 mg kg−1) injected intraperitoneally partially reversed rikkunshito preventive effect on LD/CD-inhibited GE. Rikkunshito (1.0 g kg−1) blocked LD/CD (20/2 mg kg−1)-induced delayed GE of a nutrient meal and the reduction of postprandial antral motility. In 6-hydroxydopamine-induced Parkinson’s disease rat model, rikkunshito (1.0 g kg−1, og) also prevented LD/CD-inhibited gastric emptying of a nutrient meal and enhanced fasting plasma levels of acylated ghrelin. These data indicate that oral rikkunshito alleviates the delayed GE induced by LD/CD in naïve and PD rat model in part through ghrelin-related mechanisms.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Preventive effect of rikkunshito on gastric motor function inhibited by l-dopa in rats

et al. 2014

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“…[16] GE time in patients with PD was delayed compared with control volunteers. [17] It was even slower in patients treated with levodopa,[18] which has a significant relationship between levodopa pharmacokinetics and GE in PD patients, suggesting that delayed GE is a causative factor for producing delayed-on in PD. Therefore, studies of improved GE to ameliorate delayed-on in PD are warranted.…”

Section: Parkinson's Diseasementioning

confidence: 99%

Gastrointestinal dysfunction in idiopathic Parkinsonism: A narrative review

2016

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Currently, gastrointestinal (GI) dysfunctions in Parkinson's disease (PD) are well-recognized problems and are known to be the initial symptoms in the pathological process that eventually results in PD. Many types of PD-associated GI dysfunctions have been identified, including weight loss, nausea, hypersalivation, dysphagia, dyspepsia, abdominal pain, intestinal pseudo-obstruction, constipation, defecatory dysfunction, and small intestinal bacterial overgrowth. These symptoms can influence on other PD symptoms and are the second most significant predictor of the quality of life of these patients. Recognition of GI symptoms requires vigilance on the part of clinicians. Health-care providers should routinely ask direct questions about GI symptoms during office visits so that efforts can be directed at appropriate management of these distressing manifestations. Multiple system atrophy (MSA) and progressive supranuclear palsy are two forms of neurodegenerative Parkinsonism. Symptoms of autonomic dysfunctions such as GI dysfunction are common in patients with parkinsonian disorders. Despite recent progress in the recognition of GI dysfunctions, there are a few reviews on the management of GI dysfunction and GI symptoms in idiopathic Parkinsonism. In this review, the clinical presentation, pathophysiology, and treatment of each GI symptom in PD, MSA, and prostate-specific antigen will be discussed.

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“…Effects of rikkunshito on gastroparesis in Parkinson's disease patients were reported by Doi et al [12]. Twenty patients with mild gastrointestinal symptoms were enrolled; 14 of the 20 patients had constipation.…”

Section: Resultsmentioning

confidence: 99%

Beneficial Effects of Rikkunshito, a Japanese Kampo Medicine, on Gastrointestinal Dysfunction and Anorexia in Combination with Western Drug: A Systematic Review

Mogami

Hattori

2014

Evidence-Based Complementary and Alternative Medicine

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Background. Kampo medicines are traditional herbal medicines which have been approved for medicinal use by the Japanese Ministry of Health and Welfare and are currently being used more and more, often in combination with Western drugs. Thus, the need for investigation of interactions between Kampo medicines and Western drugs is now widely recognized. Aim. To summarize the effects and drug interactions of rikkunshito, a Kampo medicine often prescribed for upper gastrointestinal disorders and anorexia. Methods. Animal and human studies were systematically reviewed to identify published data on rikkunshito. Results describing its effects were abstracted, with an emphasis on drug interactions. Results and Discussion. Rikkunshito ameliorates anorexia induced by anticancer drugs, improves quality of life scores, and can even prolong survival compared with monotherapy. Rikkunshito combined with proton pump inhibitor therapy is shown to be useful in the treatment of PPI-refractory gastroesophageal reflux disease patients and patients with gastrointestinal symptoms after endoscopic submucosal dissection. Rikkunshito reduces antidepressant-induced adverse events and improves quality of life without influencing antidepressant effects. Conclusions. Rikkunshito shows ameliorative effects on adverse reactions induced by various Western drugs and can achieve better results (e.g., anticancer drugs and proton pump inhibitor) without influencing the efficacy and bioavailability of Western drugs.

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Dietary Herb Extract Rikkunshi-To Ameliorates Gastroparesis in Parkinson's Disease: A Pilot Study

Cited by 32 publications

References 12 publications

Preventive effect of rikkunshito on gastric motor function inhibited by l-dopa in rats

Preventive effect of rikkunshito on gastric motor function inhibited by l-dopa in rats

Gastrointestinal dysfunction in idiopathic Parkinsonism: A narrative review

Beneficial Effects of Rikkunshito, a Japanese Kampo Medicine, on Gastrointestinal Dysfunction and Anorexia in Combination with Western Drug: A Systematic Review

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