Journal of Gastroenterology

, Volume 52, Issue 3, pp 308–314 | Cite as

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

  • Seiji Shimizu
  • Taku Kobayashi
  • Hideo Tomioka
  • Kensei Ohtsu
  • Toshiyuki Matsui
  • Toshifumi HibiEmail author
Original Article—Alimentary Tract



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.


Colorectal 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.

Financial support

This work was funded by Research on Rare and Intractable Diseases, Health and Labor Sciences Research Grants.


  1. 1.
    Iwashita A, Yao T, Schlemper RJ, et al. Mesenteric phlebosclerosis: a new disease entity causing ischemic colitis. Dis Colon Rectum. 2003;46:209–20.CrossRefPubMedGoogle Scholar
  2. 2.
    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).Google Scholar
  3. 3.
    Ikehata A, Hiwatashi N, Kawarada H, et al. Chronic ischemic colitis associated marked calcification of the mesenteric vessels. Dig Endosc. 1994;6:355–64.CrossRefGoogle Scholar
  4. 4.
    Maruyama Y, Watanabe F, Kanaoka S, et al. A case of phlebosclerotic ischemic colitis: a distinct entity. Endoscopy. 1997;29:334.CrossRefPubMedGoogle Scholar
  5. 5.
    Arimura Y, Kondoh Y, Kurokawa S, et al. Chronic ischemic colonic lesion caused by phlebosclerosis with calcification. Am J Gastroenterol. 1998;93:2290–2.CrossRefPubMedGoogle Scholar
  6. 6.
    Yao T, Iwashita A, Hoashi T, et al. Phlebosclerotic colitis: value of radiography in diagnosis—report of three cases. Radiology. 2000;214:188–92.CrossRefPubMedGoogle Scholar
  7. 7.
    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.CrossRefPubMedGoogle Scholar
  8. 8.
    Tsai CC, Chou JW, Chiang IP, et al. Mesenteric phlebosclerosis. Intern Med. 2008;47:183–4.CrossRefPubMedGoogle Scholar
  9. 9.
    Lin PY, Chai CY, Chang CC. Recurrent abdominal pain in a 55-year-old woman. diagnosis: idiopathic mesenteric phlebosclerosis. Gastroenterology. 2011;141(36):404.Google Scholar
  10. 10.
    Markos V, Kelly S, Yee WC, et al. Phlebosclerotic colitis: imaging findings of a rare entity. Am J Roentogenol. 2005;184:1584–6.CrossRefGoogle Scholar
  11. 11.
    Siao D, Thoeni R, Grenert JP, Day LW. A rare presentation of abdominal pain: idiopathic mesenteric phlebosclerosis. Am J Gastroenterol. 2012;107:1759–60.CrossRefPubMedGoogle Scholar
  12. 12.
    Miyazaki M, Nakamura S, Matsumoto T. Idiopathic mesenteric phlebosclerosis occurring in a wife and her husband. Clin Gastroenterol Hepatol. 2009;7:e32–3.CrossRefPubMedGoogle Scholar
  13. 13.
    Nishimura H, Nakase H, Chiba T. Sustained abdominal discomfort in a 57-year-old woman idiopathic mesenteric phlebosclerosis. Gut. 2010;59(578):594.Google Scholar
  14. 14.
    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.CrossRefPubMedGoogle Scholar
  15. 15.
    Kitamura T, Kubo M, Nakanishi T, et al. Phlebosclerosis of the colon with positive anti-centromere antibody. Intern Med. 1999;38:416–21.CrossRefPubMedGoogle Scholar
  16. 16.
    Kusanagi M, Matsui O, Kawashima H, et al. Phlebosclerotic colitis: imaging–pathologic correlation. Am J Roentogenol. 2005;185:441–7.CrossRefGoogle Scholar
  17. 17.
    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.CrossRefPubMedGoogle Scholar
  18. 18.
    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).Google Scholar
  19. 19.
    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.CrossRefPubMedGoogle Scholar

Copyright information

© Japanese Society of Gastroenterology 2016

Authors and Affiliations

  • Seiji Shimizu
    • 1
  • Taku Kobayashi
    • 2
  • Hideo Tomioka
    • 1
  • Kensei Ohtsu
    • 3
  • Toshiyuki Matsui
    • 3
  • Toshifumi Hibi
    • 2
    Email author
  1. 1.Division of Gastroenterology and HepatologyOsaka General Hospital of West Japan Railway CompanyTokyoJapan
  2. 2.Center for Advanced IBD Research and TreatmentKitasato University Kitasato Institute HospitalTokyoJapan
  3. 3.Department of GastroenterologyFukuoka University Chikushi HospitalFukuokaJapan

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