Prokinetics is one of the therapeutic agents for functional and motility disorders of the stomach. However, its efficacy is limited. Kampo medicine is a unique medical system that was developed in Japan. In Kampo medicine, herbal medicine is prescribed based on the patient’s condition. Therefore, even for functional and motility disorders of the stomach, some herbal medicines are considered as a therapeutic option. Recently, there has been an increase in evidence for the efficacy or the mechanism of herbal medicine for functional and motility disorders of the stomach. Among these, rikkunshito is a well-studied herbal medicine that could be used as an alternative to prokinetics. In this review, we discuss the possibilities of rikkunshito for functional dyspepsia with its prokinetic and non-prokinetic effects and provide an overview of their current use with a focus on their therapeutic mechanism.

Background: Rifabutin‐based regimens are used as rescue therapy for refractoryHelicobacter pyloriinfection; however, the duration for which treatment is required and side effects are concerning. This study assessed the efficacy and safety of 7‐day rifabutin, amoxicillin, and vonoprazan triple therapy as third‐ or later‐line treatment forH. pyloriinfection.Materials and Methods: Patients who did not respond to second‐line therapy were enrolled. AfterH. pyloriinfection was confirmed with the culture method, the patients received rifabutin‐containing triple therapy (20 mg vonoprazan b.i.d., 500 mg amoxicillin q.i.d., and 150 mg rifabutin q.d.) for 7 days. Twelve weeks after the eradication therapy, successful eradication was confirmed using a¹³C urea breath test or theH. pyloristool antigen test. The results obtained from our previous study that reported a 10‐day or 14‐day esomeprazole based rifabutin‐containing triple therapy as a third‐ or fourth‐line rescue therapy treated patients were used as historical control. We determined the minimum inhibitory concentrations of amoxicillin and rifabutin. We also evaluated whether the patients were positive for the mutation of therpoBgene.Results: Intention‐to‐treat and per‐protocol analyses showed that our regimen resulted in a high eradication rate (91.2%, 95% CI: 84%–99% and 92.7%, 95% CI: 86%–100%, respectively). Adverse events occurred in 31.6% of the patients, and two patients discontinued the therapy.Conclusions: This is the first study to evaluate the efficacy and safety of a 7‐day low‐dose rifabutin‐based triple therapy with vonoprazan and amoxicillin. Our results suggest that our regimen was effective and safe as a third‐ or later‐lineH. pylorieradication regimen. To clarify what component in this regimen are critical, subsequent studies using a factorial design (comparing vonoprazan‐amoxicillin dual therapy vs. vonoprazan‐rifabutin triple therapy) will be needed.

Tatsuhiro Masaoka, Hisako Kameyama, Tsuyoshi Yamane, Yuta Yamamoto, Hiroya Takeuchi, Hidekazu Suzuki, Yuko Kitagawa, and Takanori Kanai. J Neurogastroenterol Motil 2018;24:577-83. https://doi.org/10.5056/jnm18036

Introduction: In cases of effective fecal microbiota transplantation (FMT) for irritable bowel syndrome (IBS), donor feces have been observed to be enriched in Bifidobacterium spp. Moreover, FMT for functional bowel disease can improve psychiatric symptoms. Although intestinal dysbiosis has received attention as one of the pathophysiologies of IBS, the efficacy of FMT for IBS has not yet been established. In this study, we performed a post hoc analysis of the efficacy of FMT, focusing on metabolites in donor feces. Methods: FMT was performed in 12 patients, 8 with refractory diarrhea-predominant IBS and 4 with functional diarrhea (FDr), who were refractory to medical therapy. The donors were family members within a second degree of kinship and differed for each transplant. Fecal characteristics were evaluated before and 12 weeks after transplantation using the Bristol stool scale (BS). BS scores of 3–5 at 12 weeks after transplantation were considered to indicate responders, while BS scores of 6 and 7 indicated nonresponders. Metagenomic and metabolomic analyses of all 12 donor fecal samples were performed to compare the responder and nonresponder groups. Results: Before transplantation, all patients had BS scores of 6–7, but 12 weeks after transplantation, 6 were considered responders and 6 were nonresponders. Metagenomic analysis showed that effective donor feces contained significantly higher levels of Prevotella than did the ineffective donor feces. Metabolomic analysis showed that effective donor feces contained significantly higher levels of propionate and butyrate and significantly lower lactate levels than did ineffective donor feces. Conclusion: Propionate-, butyrate-, or Prevotella-rich donor feces may contribute to successful FMT in patients with diarrhea-dominant functional gastrointestinal disorders.