Yoshida Naohisa, Yasuda Takeshi, Inagaki Yoshikazu, Hasegawa Daisuke, Fukumoto Kohei, Murakami Takaaki, Hirose Ryohei, Dohi Osamu, Uchiyama Kazuhiko, Takagi Tomohisa, Itoh Yoshito
Department of Molecular Gastroenterology and Hepatology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan.
Department of Gastroenterology, Akashi City Hospital, Hyogo, Japan.
J Anus Rectum Colon. 2025 Jan 25;9(1):105-116. doi: 10.23922/jarc.2024-068. eCollection 2025.
Effective treatments for diarrhea-type irritable bowel syndrome (IBS-D) are limited. Hangeshashinto (HST), an anti-inflammatory Kampo medicine, may offer benefits but its efficacy for IBS-D requires further investigation. This study evaluated IBS-D symptom improvement and gut microbiota changes following HST administration.
This was a multicenter retrospective study with a prospective analysis of microbiota conducted at five affiliated institutions. Patients diagnosed with IBS-D based on the ROME IV criteria between April 2019 and December 2023, who received HST 7.5 g/day for 2-3 weeks were included. The outcome measures were improvement rates in overall symptoms, stool frequency, stool consistency, and abdominal pain. Intestinal microbiota was analyzed using 16S rRNA gene sequencing from fecal samples of 20 patients before and after HST treatment.
One hundred patients (42 males/58 females, mean age: 69.5±11.8 years) were analyzed. The overall improvement rate of HST was 82.0%. Those of males and females were 81.0% and 82.8% (p=0.816). By age, those of patients aged ≥75 and aged <75 years were 82.9% and 81.5% (p=0.869). The improvement rates of stool frequency, stool consistency, and abdominal pain were 59.0%, 51.0%, and 62.0%, respectively. The stool frequency per week before and after HST was 21.7±18.2 vs. 14.0±12.6 (p<0.001). Significant differences in gut microbiota β diversity were observed, although α diversity was not significantly changed. (p=0.003) and (p=0.010) decreased significantly, while (p=0.030) and (p=0.002) increased.
HST may improve IBS-D symptoms by altering microbiota composition.
腹泻型肠易激综合征（IBS-D）的有效治疗方法有限。汉方抗炎药半夏泻心汤（HST）可能有益，但它对IBS-D的疗效需要进一步研究。本研究评估了服用HST后IBS-D症状的改善情况以及肠道微生物群的变化。
这是一项多中心回顾性研究，并在五个附属医院对微生物群进行了前瞻性分析。纳入了2019年4月至2023年12月期间根据罗马IV标准诊断为IBS-D且每天接受7.5 g HST治疗2至3周的患者。观察指标为总体症状、大便频率、大便性状和腹痛的改善率。使用16S rRNA基因测序分析了20例患者在HST治疗前后粪便样本中的肠道微生物群。
共分析了100例患者（42例男性/58例女性，平均年龄：69.5±11.8岁）。HST的总体改善率为82.0%。男性和女性的改善率分别为81.0%和82.8%（p = 0.816）。按年龄划分，≥75岁和<75岁患者的改善率分别为82.9%和81.5%（p = 0.869）。大便频率、大便性状和腹痛的改善率分别为59.0%、51.0%和62.0%。HST治疗前后每周的大便频率分别为21.7±18.2次和14.0±12.6次（p<0.001）。虽然α多样性没有显著变化，但观察到肠道微生物群β多样性有显著差异（p = 0.003），（p = 0.010）显著降低，而（p = 0.030）和（p = 0.002）增加。
HST可能通过改变微生物群组成来改善IBS-D症状。
