Clinical outcomes, histopathological patterns, and chemical analysis of Ayurveda and herbal medicine associated with severe liver injury—A single-center experience from southern India

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 s...

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Bibliographic Details
Published in:Indian journal of gastroenterology 2018-01, Vol.37 (1), p.9-17
Main Authors: Philips, Cyriac Abby, Paramaguru, Rajaguru, Joy, Adarsh K., Antony, K. L., Augustine, Philip
Format: Article
Language:English
Subjects:
Adult
Arsenicals - metabolism
Chemical and Drug Induced Liver Injury - etiology
Chemical and Drug Induced Liver Injury - metabolism
Chemical and Drug Induced Liver Injury - mortality
Chemical and Drug Induced Liver Injury - pathology
Drugs, Chinese Herbal - adverse effects
Female
Follow-Up Studies
Gastroenterology
Hepatology
Herbal Medicine
Humans
Liver - pathology
Male
Medicine
Medicine & Public Health
Medicine, Ayurvedic - adverse effects
Mercury Compounds - metabolism
Middle Aged
Original Article
Risk
Severity of Illness Index
Time Factors
Volatile Organic Compounds - metabolism
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Summary: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  
ISSN:0254-8860
0975-0711
DOI:10.1007/s12664-017-0815-8