| Title: | "Clinical outcomes, histopathological patterns, and chemical analysis of Ayurveda and herbal medicine associated with severe liver injury-A single-center experience from southern India" |
| Author(s): | Philips CA; Paramaguru R; Joy AK; Antony KL; Augustine P; |
| Address: | "Department of Hepatology and Liver Transplant Medicine, PVS Memorial Hospital, Kochi, 682 025, India. abbyphilips@gmail.com. Department of Pathology, PVS Memorial Hospital, Kochi, 682 025, India. Sophisticated Test and Instrumentation Centre, Cochin University of Science and Technology, Kochi, 682 022, India. Envirodesigns Eco Labs, Kochi, 682 025, India. Department of Gastroenterology, PVS Memorial Hospital, Kochi, 682 025, India" |
| DOI: | 10.1007/s12664-017-0815-8 |
| ISSN/ISBN: | 0975-0711 (Electronic) 0254-8860 (Linking) |
| Abstract: | "INTRODUCTION: Ayurvedic and herbal medicines (AHM) are known to cause varying degrees of drug-induced liver injury (DILI). Clinical, biochemical, histological spectrum and outcomes of AHM linked to severe DILI are not well studied. METHODS: Out of 1440 liver disease patients, 94 were found to have a severe liver injury and associated AHM intake. Thirty-three patients were suspected to have AHM-DILI on Roussel Uclaf Causality Assessment Scoring Method. Forty-seven and 30 of retrieved AHM samples were analyzed for heavy metals and hepatotoxic volatile organic compounds (hVOCs), respectively. Eleven patients ingested AHM from unregistered traditional healers (UTH). Clinicopathological outcomes were analyzed in 27 patients (who underwent liver biopsy) and outcomes with respect to chemical analyses were studied in 33 patients. RESULTS: Males predominated (70.4%) with mean age 46.9+/-15.8 years. Mean follow up was 119.2+/-81.4 days. The median duration of drug intake was 28 days (10 - 84). Five patients died (18.5%). Hepatic encephalopathy, hypoalbuminemia, and hepatic necrosis were significantly associated with mortality (p < 0.005). Arsenic and mercury ingestion was significantly associated with death (p < 0.005). hVOCs were detected in more than 70% of samples. AHM intake from UTH was associated with higher mortality. CONCLUSION: Adequate regulation and scrutiny regarding AHM use among the general population is an unmet need. Early liver biopsy after clinical identification of at-risk patients can expedite definitive treatment with a liver transplant" |
| Keywords: | "Adult Arsenicals/metabolism Chemical and Drug Induced Liver Injury/*etiology/metabolism/mortality/pathology Drugs, Chinese Herbal/*adverse effects Female Follow-Up Studies *Herbal Medicine Humans Liver/pathology Male Medicine, Ayurvedic/*adverse effects M;" |
| Notes: | "MedlinePhilips, Cyriac Abby Paramaguru, Rajaguru Joy, Adarsh K Antony, K L Augustine, Philip eng India 2018/02/25 Indian J Gastroenterol. 2018 Jan; 37(1):9-17. doi: 10.1007/s12664-017-0815-8. Epub 2018 Feb 24" |
