Abstract
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.
Similar content being viewed by others
References
Iwashita A, Yao T, Schlemper RJ, et al. Mesenteric phlebosclerosis: a new disease entity causing ischemic colitis. Dis Colon Rectum. 2003;46:209–20.
Koyama N, Koyama H, Hanajima T, et al. Chronic ischemic colitis causing stenosis, report of a case. Stom Intest. 1991;26:455–60 (In Japanese).
Ikehata A, Hiwatashi N, Kawarada H, et al. Chronic ischemic colitis associated marked calcification of the mesenteric vessels. Dig Endosc. 1994;6:355–64.
Maruyama Y, Watanabe F, Kanaoka S, et al. A case of phlebosclerotic ischemic colitis: a distinct entity. Endoscopy. 1997;29:334.
Arimura Y, Kondoh Y, Kurokawa S, et al. Chronic ischemic colonic lesion caused by phlebosclerosis with calcification. Am J Gastroenterol. 1998;93:2290–2.
Yao T, Iwashita A, Hoashi T, et al. Phlebosclerotic colitis: value of radiography in diagnosis—report of three cases. Radiology. 2000;214:188–92.
Chang KM. New histologic findings in idiopathic mesenteric phlebosclerosis: clues to its pathogenesis and etiology—probably ingested toxic agent-related. J Chin Med Assoc. 2007;70:227–35.
Tsai CC, Chou JW, Chiang IP, et al. Mesenteric phlebosclerosis. Intern Med. 2008;47:183–4.
Lin PY, Chai CY, Chang CC. Recurrent abdominal pain in a 55-year-old woman. diagnosis: idiopathic mesenteric phlebosclerosis. Gastroenterology. 2011;141(36):404.
Markos V, Kelly S, Yee WC, et al. Phlebosclerotic colitis: imaging findings of a rare entity. Am J Roentogenol. 2005;184:1584–6.
Siao D, Thoeni R, Grenert JP, Day LW. A rare presentation of abdominal pain: idiopathic mesenteric phlebosclerosis. Am J Gastroenterol. 2012;107:1759–60.
Miyazaki M, Nakamura S, Matsumoto T. Idiopathic mesenteric phlebosclerosis occurring in a wife and her husband. Clin Gastroenterol Hepatol. 2009;7:e32–3.
Nishimura H, Nakase H, Chiba T. Sustained abdominal discomfort in a 57-year-old woman idiopathic mesenteric phlebosclerosis. Gut. 2010;59(578):594.
Hiramatsu K, Sakata H, Horita Y, et al. Mesenteric phlebosclerosis associated with long-term oral intake of geniposide, an ingredient of herbal medicine. Aliment Pharmacol Ther. 2012;36:575–86.
Kitamura T, Kubo M, Nakanishi T, et al. Phlebosclerosis of the colon with positive anti-centromere antibody. Intern Med. 1999;38:416–21.
Kusanagi M, Matsui O, Kawashima H, et al. Phlebosclerotic colitis: imaging–pathologic correlation. Am J Roentogenol. 2005;185:441–7.
Oshitani N, Matsumura Y, Kono M, et al. Asymptomatic chronic intestinal ischemia caused by idiopathic phlebosclerosis of mesenteric vein. Dig Dis Sci. 2002;47:2711–4.
Shimizu K, Shimizu S, Koga H, et al. Serial endoscopic changes in mesenteric phlebosclerosis, report of a case and a review of the literature. Stom Intest. 2009;44:259–66 (In Japanese).
Kato T, Miyazaki K, Nakamura T, et al. Perforated phlebosclerotic colitis—description of a case and review of this condition. Colorectal Dis. 2010;12:149–51.
Acknowledgments
We express our deep appreciation to all investigators who contributed to this survey, especially the following doctors who provided descriptions of their patients: Kensei Ohtsu (Fukuoka University Chikushi Hospital), Masashi Fukushima, Tetsuro Inokuma (Kobe City Medical Center General Hospital), Shinji Yoshii (NTT Higashinihon Sapporo Hospital), Hideo Tomioka, Seiji Shimizu (Osaka General Hospital of West Japan Railway Company), Koji Sano (Osaka City General Hospital), Ichiro Hirata (Fujita Health University Hospital), Masayuki Saruta, Seiji Arihiro, Hisao Tajiri (The Jikei University Hospital), Takuji Kawamura (Kyoto Second Red Cross Hospital), Juichi Sakamoto (Hirosaki Municipal Hospital), Masaaki Miyaoka (Tokyo Medical University Hachioji Medical Center), Taku Tabata (Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital), Katsushi Hiramatsu (University of Fukui Hospital), Naohiko Harada (National Kyushu Medical Center), Toshihiko Tomita, Katsuyuki Tozawa (Hyogo College of Medicine), Wataru Ueda, Kiyotaka Ookawa (Osaka City Juso Hospital), Kazuyuki Kanemasa (Nara City Hospital), Toshihiro Kusaka (Kyoto Katsura Hospital), Kaoru Yokoyama (Kitasato University East Hospital).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The author(s) declare that they have no competing interests.
Financial support
This work was funded by Research on Rare and Intractable Diseases, Health and Labor Sciences Research Grants.
Rights and permissions
About this article
Cite this article
Shimizu, S., Kobayashi, T., Tomioka, H. et al. Involvement of herbal medicine as a cause of mesenteric phlebosclerosis: results from a large-scale nationwide survey. J Gastroenterol 52, 308–314 (2017). https://doi.org/10.1007/s00535-016-1218-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00535-016-1218-9