Daikenchuto, a traditional Japanese herbal medicine, for the maintenance of surgically induced remission in patients with Crohn’s disease: a retrospective analysis of 258 patients

• Published in: Surgery today (Tokyo, Japan) Vol. 44; no. 8; pp. 1506 - 1512
• Main Authors: Kanazawa, Amane, Sako, Minako, Takazoe, Masakazu, Tadami, Tokuma, Kawaguchi, Takaaki, Yoshimura, Naoki, Okamoto, Kinya, Yamana, Tetsuo, Sahara, Rikisaburo
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01.08.2014
• Subjects: Adult; Crohn Disease - drug therapy; Crohn Disease - prevention & control; Crohn Disease - surgery; Female; Humans; Maintenance Chemotherapy; Male; Medicine; Medicine & Public Health; Mesalamine - administration & dosage; Original; Original Article; Plant Extracts - administration & dosage; Postoperative Care; Recurrence; Remission Induction; Reoperation - statistics & numerical data; Retrospective Studies; Surgery; Surgical Oncology; Time Factors; Daikenchuto; Reoperation rate; 5-aminosalicylic acid; Crohn’s disease
• ISSN: 0941-1291; 1436-2813
• DOI: 10.1007/s00595-013-0747-6

Purpose Despite numerous studies, the best postoperative therapy for Crohn’s disease is still undefined. We retrospectively evaluated the effects of postoperative maintenance therapy with daikenchuto, a traditional Japanese Kampo medicine, on the reoperation rate at 3 years in patients with Crohn’s disease. Methods A total of 258 patients who underwent surgery for Crohn’s disease were identified for the study. For the prevention of postoperative recurrence, patients were stratified to receive 5-aminosalicylic acid, azathioprine or daikenchuto, and their effects on preventing reoperation at 3 years were evaluated. Results Of the 258 patients, 44 required reoperation with intestinal resection within 3 years due to disease recurrence. The 3-year reoperation rate was significantly lower in the postoperative daikenchuto group than in the non-daikenchuto group (11.3 vs. 24.5 %, P  = 0.01), and was similarly significantly lower in the postoperative 5-aminosalicylic acid group than in the non-5-aminosalicylic acid group (14.8 vs. 29.6 %, P  = 0.0049). A multivariate Cox analysis showed that postoperative daikenchuto ( P  = 0.035) and postoperative 5-aminosalicylic acid ( P  = 0.022) were significantly and independently associated with the rate of reoperation at 3 years in patients with Crohn’s disease. Conclusion We propose that continuous daikenchuto therapy is a clinically useful and feasible maintenance therapy for the prevention of postoperative reoperation in patients with Crohn’s disease.