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Cited by 66Drug-Induced Hepatotoxicity and ProtectionComplementary and Alternative Medicine StudiesNephrotoxicity and Medicinal Plants

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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

Philips, Cyriac Abby, Paramaguru, Rajaguru, Joy, Adarsh K., Antony, K. L., Augustine, Philip·2018·Indian Journal of Gastroenterology
DOI 10.1007/s12664-017-0815-8
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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 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.

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Metadata

Authors
Philips, C. A., Paramaguru, R., Joy, A. K., Antony, K. L., & Augustine, P.
Affiliations
  • PVS Memorial Hospital (IN)
  • Cochin University of Science and Technology (IN)
Corresponding author
Philips, Cyriac Abby
ORCID
Venue
Indian Journal of Gastroenterology
Publisher
Springer Science and Business Media LLC
Published
2018-01
Volume
37
Issue
1
Pages
9-17
ISSN
  • 0254-8860 (ISSN-L)
  • 0975-0711
DOI
10.1007/s12664-017-0815-8
OpenAlex
W2792979708
Cited by
66
References
1
Citations by year
2026: 4 · 2025: 4 · 2024: 6 · 2023: 8 · 2022: 7 · 2021: 10 · 2020: 6 · 2019: 12 · 2018: 8
FWCI
6.34
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Indian Journal of Gastroenterology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Drug-Induced Hepatotoxicity and Protection
  • Health Sciences › Medicine › Complementary and alternative medicine › Complementary and Alternative Medicine Studies
  • Health Sciences › Medicine › Nephrology › Nephrotoxicity and Medicinal Plants
Keywords
drug-induced liver injury, hepatotoxicity, herbal medicine safety, heavy metals, arsenic, mercury, volatile organic compounds, liver biopsy, liver necrosis, hepatic encephalopathy, mortality, liver transplantation
MeSH terms
Adult, Arsenicals, Drugs, Chinese Herbal, Female, Follow-Up Studies, Humans, Liver, Male, Medicine, Ayurvedic, Middle Aged, Risk, Severity of Illness Index, Time Factors, Mercury Compounds, Herbal Medicine, Volatile Organic Compounds, Chemical and Drug Induced Liver Injury

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