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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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| Published in: | Indian journal of gastroenterology 2018-01, Vol.37 (1), p.9-17 |
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| container_title | Indian journal of gastroenterology |
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| creator | Philips, Cyriac Abby Paramaguru, Rajaguru Joy, Adarsh K. Antony, K. L. Augustine, Philip |
| description | 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
|
| doi_str_mv | 10.1007/s12664-017-0815-8 |
| format | article |
| fullrecord | <record><control><sourceid>pubmed_cross</sourceid><recordid>TN_cdi_crossref_primary_10_1007_s12664_017_0815_8</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>29476406</sourcerecordid><originalsourceid>FETCH-LOGICAL-c414t-dba548f620fc9fecffb4bb6d9193a6c9772cf8b53a8191ebb488ab44690e6f543</originalsourceid><addsrcrecordid>eNp9UU1uGyEYRVWi5q8H6CbiAKGFMcPA0rKSNlKkbpL1CJgPD9YMWDCT1LscIpfpdXqSYrvNsquPj_cDeg-hz4x-YZQ2XzOrhOCEsoZQyWoiP6Bzqpqa0Iaxk3Kuak6kFPQMXeS8oftdLT6is0rxRnAqztGv1eCDt3rAcZ5sHCHf4N7nKW711Mchrg9YWSZIoWA6dNj2MB6uddDDLvuMo8PL3ZyeodMHRg_JFHyEzlsfAOuco_V6gg6_-KnHGZ4hAR58GdiHzZx2v1_fljj7sB6AWAjlOQw_t5A8BAvYpTjiXL5YnAO-D53XV-jU6SHDp7_zEj3d3T6uvpOHH9_uV8sHYjnjE-mMrrl0oqLOKgfWOcONEZ1iaqGFVU1TWSdNvdCSKQbGcCm14VwoCsLVfHGJ2NHXpphzAtdukx912rWMtvsa2mMNbamh3dfQyqK5Pmq2sykhvCv-5V4I1ZGQCxTWkNpNnFOJM__H9Q9uBZon</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><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</title><source>Springer Nature</source><creator>Philips, Cyriac Abby ; Paramaguru, Rajaguru ; Joy, Adarsh K. ; Antony, K. L. ; Augustine, Philip</creator><creatorcontrib>Philips, Cyriac Abby ; Paramaguru, Rajaguru ; Joy, Adarsh K. ; Antony, K. L. ; Augustine, Philip</creatorcontrib><description>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.</description><identifier>ISSN: 0254-8860</identifier><identifier>EISSN: 0975-0711</identifier><identifier>DOI: 10.1007/s12664-017-0815-8</identifier><identifier>PMID: 29476406</identifier><language>eng</language><publisher>New Delhi: Springer India</publisher><subject>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</subject><ispartof>Indian journal of gastroenterology, 2018-01, Vol.37 (1), p.9-17</ispartof><rights>Indian Society of Gastroenterology 2018</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c414t-dba548f620fc9fecffb4bb6d9193a6c9772cf8b53a8191ebb488ab44690e6f543</citedby><cites>FETCH-LOGICAL-c414t-dba548f620fc9fecffb4bb6d9193a6c9772cf8b53a8191ebb488ab44690e6f543</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/29476406$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Philips, Cyriac Abby</creatorcontrib><creatorcontrib>Paramaguru, Rajaguru</creatorcontrib><creatorcontrib>Joy, Adarsh K.</creatorcontrib><creatorcontrib>Antony, K. L.</creatorcontrib><creatorcontrib>Augustine, Philip</creatorcontrib><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</title><title>Indian journal of gastroenterology</title><addtitle>Indian J Gastroenterol</addtitle><addtitle>Indian J Gastroenterol</addtitle><description>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.</description><subject>Adult</subject><subject>Arsenicals - metabolism</subject><subject>Chemical and Drug Induced Liver Injury - etiology</subject><subject>Chemical and Drug Induced Liver Injury - metabolism</subject><subject>Chemical and Drug Induced Liver Injury - mortality</subject><subject>Chemical and Drug Induced Liver Injury - pathology</subject><subject>Drugs, Chinese Herbal - adverse effects</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gastroenterology</subject><subject>Hepatology</subject><subject>Herbal Medicine</subject><subject>Humans</subject><subject>Liver - pathology</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Medicine, Ayurvedic - adverse effects</subject><subject>Mercury Compounds - metabolism</subject><subject>Middle Aged</subject><subject>Original Article</subject><subject>Risk</subject><subject>Severity of Illness Index</subject><subject>Time Factors</subject><subject>Volatile Organic Compounds - metabolism</subject><issn>0254-8860</issn><issn>0975-0711</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2018</creationdate><recordtype>article</recordtype><recordid>eNp9UU1uGyEYRVWi5q8H6CbiAKGFMcPA0rKSNlKkbpL1CJgPD9YMWDCT1LscIpfpdXqSYrvNsquPj_cDeg-hz4x-YZQ2XzOrhOCEsoZQyWoiP6Bzqpqa0Iaxk3Kuak6kFPQMXeS8oftdLT6is0rxRnAqztGv1eCDt3rAcZ5sHCHf4N7nKW711Mchrg9YWSZIoWA6dNj2MB6uddDDLvuMo8PL3ZyeodMHRg_JFHyEzlsfAOuco_V6gg6_-KnHGZ4hAR58GdiHzZx2v1_fljj7sB6AWAjlOQw_t5A8BAvYpTjiXL5YnAO-D53XV-jU6SHDp7_zEj3d3T6uvpOHH9_uV8sHYjnjE-mMrrl0oqLOKgfWOcONEZ1iaqGFVU1TWSdNvdCSKQbGcCm14VwoCsLVfHGJ2NHXpphzAtdukx912rWMtvsa2mMNbamh3dfQyqK5Pmq2sykhvCv-5V4I1ZGQCxTWkNpNnFOJM__H9Q9uBZon</recordid><startdate>20180101</startdate><enddate>20180101</enddate><creator>Philips, Cyriac Abby</creator><creator>Paramaguru, Rajaguru</creator><creator>Joy, Adarsh K.</creator><creator>Antony, K. L.</creator><creator>Augustine, Philip</creator><general>Springer India</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>20180101</creationdate><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</title><author>Philips, Cyriac Abby ; Paramaguru, Rajaguru ; Joy, Adarsh K. ; Antony, K. L. ; Augustine, Philip</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c414t-dba548f620fc9fecffb4bb6d9193a6c9772cf8b53a8191ebb488ab44690e6f543</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adult</topic><topic>Arsenicals - metabolism</topic><topic>Chemical and Drug Induced Liver Injury - etiology</topic><topic>Chemical and Drug Induced Liver Injury - metabolism</topic><topic>Chemical and Drug Induced Liver Injury - mortality</topic><topic>Chemical and Drug Induced Liver Injury - pathology</topic><topic>Drugs, Chinese Herbal - adverse effects</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Gastroenterology</topic><topic>Hepatology</topic><topic>Herbal Medicine</topic><topic>Humans</topic><topic>Liver - pathology</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Medicine, Ayurvedic - adverse effects</topic><topic>Mercury Compounds - metabolism</topic><topic>Middle Aged</topic><topic>Original Article</topic><topic>Risk</topic><topic>Severity of Illness Index</topic><topic>Time Factors</topic><topic>Volatile Organic Compounds - metabolism</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Philips, Cyriac Abby</creatorcontrib><creatorcontrib>Paramaguru, Rajaguru</creatorcontrib><creatorcontrib>Joy, Adarsh K.</creatorcontrib><creatorcontrib>Antony, K. L.</creatorcontrib><creatorcontrib>Augustine, Philip</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><jtitle>Indian journal of gastroenterology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Philips, Cyriac Abby</au><au>Paramaguru, Rajaguru</au><au>Joy, Adarsh K.</au><au>Antony, K. L.</au><au>Augustine, Philip</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical outcomes, histopathological patterns, and chemical analysis of Ayurveda and herbal medicine associated with severe liver injury—A single-center experience from southern India</atitle><jtitle>Indian journal of gastroenterology</jtitle><stitle>Indian J Gastroenterol</stitle><addtitle>Indian J Gastroenterol</addtitle><date>2018-01-01</date><risdate>2018</risdate><volume>37</volume><issue>1</issue><spage>9</spage><epage>17</epage><pages>9-17</pages><issn>0254-8860</issn><eissn>0975-0711</eissn><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.</abstract><cop>New Delhi</cop><pub>Springer India</pub><pmid>29476406</pmid><doi>10.1007/s12664-017-0815-8</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| 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 |
| 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 |
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