Effects of Rikkunshito (traditional Japanese medicine) on enteral feeding and the plasma ghrelin level in critically ill patients : a pilot study

摘要

Background: Rikkunshito is a traditional Japanese medicine that has been widely prescribed for patients withvarious gastrointestinal symptoms. Recently, the prokinetic effects of Rikkunshito in patients with a variety ofdiseases have attracted attention in Japan. The prokinetic effects of Rikkunshito are believed to result from anincrease of active ghrelin, which is most abundant in the stomach and which has a gastrokinetic function. The aimof the present pilot study was to investigate the effects of Rikkunshito on intragastric enteral feeding and plasmaghrelin levels in critically ill patients. Methods: The study population consisted of critically ill patients who were projected to require intragastric tubefeeding for more than 7 days. The patients were prospectively assigned to one of two treatment groups and wererandomized to receive either Rikkunshito (2.5 g) or metoclopramide (10 mg) every 8 h. All patients receivedstandard enteral nutrition. Patients in both groups were begun on intragastric tube feeding according to ourinstitution’s feeding protocol. Results: All patients were undergoing mechanical ventilation at the time of enrollment. The portions of enteralnutrition provided to the target amount and the quantity of gastric discharge were not statistically significantlydifferent between the two groups. The Rikkunshito group reached 50% of the target amount of enteral feedingsignificantly earlier than the metoclopramide group, although the proportion of patients in whom enteral feedingwas successful did not differ significantly between the two groups. Patients in the Rikkunshito group showedsignificantly higher plasma levels of active ghrelin compared to those in the metoclopramide group. Conclusions: The administration of Rikkunshito increased the plasma level of active ghrelin, and induced prokineticeffects that were greater than those observed following treatment with metoclopramide in critically ill patients. Trial registration: UMIN00000356