Involvement of herbal medicine as a cause of mesenteric phlebosclerosis: results from a large-scale nationwide survey
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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.
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.
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.
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.
KeywordsColorectal diseases Colorectal pathology Drug toxicity Inflammatory bowel disease
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).
Compliance with ethical standards
Conflict of interest
The author(s) declare that they have no competing interests.
This work was funded by Research on Rare and Intractable Diseases, Health and Labor Sciences Research Grants.
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