Involvement of herbal medicine as a cause of mesenteric phlebosclerosis: results from a large-scale nationwide survey

• Published in: Journal of gastroenterology Vol. 52; no. 3; pp. 308 - 314
• Main Authors: Shimizu, Seiji, Kobayashi, Taku, Tomioka, Hideo, Ohtsu, Kensei, Matsui, Toshiyuki, Hibi, Toshifumi
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01-03-2017; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Adult; Aged; Aged, 80 and over; Colorectal Surgery; Drug Utilization - statistics & numerical data; Drugs; Drugs, Chinese Herbal - adverse effects; Female; Follow-Up Studies; Gardenia; Gardenia jasminoides; Gastroenterology; Health Surveys; Hepatology; Humans; Japan - epidemiology; Male; Medicine; Medicine & Public Health; Medicine, Kampo - adverse effects; Mesenteric Veins - diagnostic imaging; Middle Aged; Original Article—Alimentary Tract; Phytotherapy - adverse effects; Political aspects; Radiography; Retrospective Studies; Sclerosis; Surgical Oncology; Surveys; Tomography, X-Ray Computed; Vascular Calcification - chemically induced; Vascular Calcification - diagnostic imaging; Vascular Calcification - epidemiology; Colorectal pathology; Inflammatory bowel disease; Colorectal diseases; Drug toxicity
• ISSN: 0944-1174; 1435-5922
• DOI: 10.1007/s00535-016-1218-9

Background
Mesenteric phlebosclerosis (MP) is a rare disease characterized by venous calcification extending from the colonic wall to the mesentery, with chronic ischemic changes from venous return impairment in the intestine. It is an idiopathic disease, but increasing attention has been paid to the potential involvement of herbal medicine, or Kampo, in its etiology. Until now, there were scattered case reports, but no large-scale studies have been conducted to unravel the clinical characteristics and etiology of the disease.
Methods
A nationwide survey was conducted using questionnaires to assess possible etiology (particularly the involvement of herbal medicine), clinical manifestations, disease course, and treatment of MP.
Results
Data from 222 patients were collected. Among the 169 patients (76.1 %), whose history of herbal medicine was obtained, 147 (87.0 %) used herbal medicines. The use of herbal medicines containing
sanshishi
(gardenia fruit,
Gardenia jasminoides
Ellis) was reported in 119 out of 147 patients (81.0 %). Therefore, the use of herbal medicine containing
sanshishi
was confirmed in 70.4 % of 169 patients whose history of herbal medicine was obtained. The duration of
sanshishi
use ranged from 3 to 51 years (mean 13.6 years). Patients who discontinued
sanshishi
showed a better outcome compared with those who continued it.
Conclusions
The use of herbal medicine containing
sanshishi
is associated with the etiology of MP. Although it may not be the causative factor, it is necessary for gastroenterologists to be aware of the potential risk of herbal medicine containing sanshishi for the development of MP.