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Complementary and alternative medicine in the treatment of chronic liver disease

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Abstract

Interest in and use of complementary and alternative medicines (CAM) in the treatment of chronic liver diseases has increased in the past decade. However, this has not been supported by a significant increase in sound clinical research evidence for their efficacy. The research literature is growing, providing improved knowledge on population use of CAM, possible mechanisms of action of a large range of complementary and alternative medications, and possible specific indications for these agents in patients with liver disease. Although curative potential for CAM has not been documented consistently in any liver disorder, it is possible to identify anti-inflammatory activity and cytoprotective capacity for a number of agents from different branches of the world of CAM. Evidence grows for potential harm from an increasing number of compounds. Concurrently, clarity is increasing in relation to which specific constituents cause the harm and the mechanisms by which damage is produced.

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References and Recommended Reading

  1. MacLennan AH, Wilson DH, Taylor AW: The escalating costs and prevalence of alternative medicine. Prevent Med 2002, 35:166–173.

    Article  Google Scholar 

  2. Eisenberg DM, Kessler RD, Van Rompay MI, et al.: Perceptions about complementary therapies relative to conventional therapies among adults who use both: results from a national survey. Ann Intern Med 2001, 135:344–351.

    PubMed  CAS  Google Scholar 

  3. Fogden E, Neuberger J: Alternative medicines and the liver. Liver Int 2003, 23:213–220. This review is of value because it summarizes the extent of use of CAM in liver clinic patients, examines the utility of a number of commonly used agents, and discusses safety aspects of CAM usage. The authors conclude that data are insufficient to allow any recommendations for use of CAM in liver disease at present.

    Article  PubMed  CAS  Google Scholar 

  4. Complementary Medicines, UK [market report]. London: Mintel International Group; 2003.

  5. Seeff LB, Lindsay KL, Bacon BR, et al.: Complementary and alternative medicine in chronic liver disease. Hepatology 2001, 34:595–603.

    Article  PubMed  CAS  Google Scholar 

  6. McCulloch M, Broffman M, Gao J, Colford JM Jr: Chinese herbal medicine and interferon in the treatment of chronic hepatitis B: a meta-analysis of randomized, controlled trials. Am J Public Health 2002, 92:1619–1627.

    Article  PubMed  Google Scholar 

  7. Coon JT, Ernst E: Complementary and alternative therapies in the treatment of chronic hepatitis C: a systematic review. J Hepatol 2004, 40:491–500.

    Article  PubMed  Google Scholar 

  8. Batey RG, Cao Q: CH100, a Chinese herbal preparation, protects against Con A mediated hepatitis in alcohol consuming rats. Alcoholism Clin Exp Res 2000, 62:381–385.

    Google Scholar 

  9. Milne GWA, ed: Traditional Chinese Medicines: Molecular Structures, Natural Sources and Applications. Aldershot, UK: Ashgate Press; 2001.

    Google Scholar 

  10. Williamson EM: Review. Synergy and other interactions in phytomedicines. Phytomedicine 2001, 8:410–409.

    Article  Google Scholar 

  11. Lieber CS, Leo MA, Cao Q, et al.: Silymarin retards the progression of alcohol-induced hepatic fibrosis in baboons. J Clin Gastroenterol 2003, 37:336–339. This study offers a possible explanation as to why the excellent results achieved with silymarin in alcohol-related animal studies in particular may be hard to emulate in human studies.

    Article  PubMed  CAS  Google Scholar 

  12. Sakaida I, Matsumara Y, Akiyama S, et al.: Herbal medicine, Sho-saiko-to (TJ-9) prevents liver fibrosis induced by a choline-deficient L-amino acid-defined diet. J Hepatol 1998, 29:642–649.

    Article  PubMed  Google Scholar 

  13. Li YM, Ryan P, Batey RG: Traditional Chinese medicine prevents inflammation in CCl.4-related liver injury in mice. Am J Chinese Med 2003, 31:119–127.

    Article  CAS  Google Scholar 

  14. Hewawasam RP, Jayatilaka KA, Pathirana C, Mudduwa LK: Hepatoprotective effects of Epaltes divaricata extract on carbon tetrachloride induced hepatotoxicity in rats. Indian J Med Res 2004, 10:1037–1042.

    Google Scholar 

  15. Luo YJ, Uyu JP, Shi ZH, Wang L: Ginkgo biloba extract reverses CCl4-induced liver fibrosis in rats. World J Gastroenterol 2004, 10:1037–1042.

    PubMed  CAS  Google Scholar 

  16. Lee TY, Mai LM, Wang GJ, et al.: Protective mechanism of Salvia miltiorrhiza on carbon tetrachloride induced acute hepatotoxicity in rats. J Pharmacol Sci 2003, 91:202–211.

    Article  PubMed  CAS  Google Scholar 

  17. Muriel P, Moreno MG: Effects of silymarin and vitamins E and C on liver damage induced by prolonged biliary obstruction in the rat. Basic Clin Pharmacol Toxicol 2004, 94:99–104.

    PubMed  CAS  Google Scholar 

  18. Flora K, Hahn M, Rosen H, Benner K: Milk thistle for the therapy of liver disease Am J Gastroenterol 1998, 93:139–143.

    Article  PubMed  CAS  Google Scholar 

  19. Van Rossum TG, Vulto AG, De Man RA, et al.: Review article: Glycyrrhizin as a potential treatment for chronic hepatitis C. Alimentary Pharmacol Ther 1998,12:199–205.

    Article  Google Scholar 

  20. Chang IM: Antiviral activities of aucubin against hepatitis B virus replication. Phyto Res 1997,11:189–192.

    Article  Google Scholar 

  21. Jeong HJ, Koo HN, Na HJ et al.: Inhibition of TNF-alpha and IL-6 production by aucubin through blockade of NF-kappaB activation RBL-2H3 mast cells. Cytokine 2002, 18:252–259. A valuable paper demonstrating the capacity of aucubin to modulate tumor necrosis factor (TNF)-’a and interleukin (IL)-6 production in mast cells via inhibition of NFêB activation. Although it does not study liver disease directly, the work points to possible mechanisms of action of other alternative medicines and should serve as a template for future experiments.

    Article  PubMed  CAS  Google Scholar 

  22. Ott M, Thayagarajan SP, Gupta S: Phyllanthus amarus suppresses hepatitis B virus by interrupting interactions between HBV enhancer I and cellular transcription factors. Eur J Clin Invest 1997, 27:908–915.

    Article  PubMed  CAS  Google Scholar 

  23. Oka H, Yamamoto S, Kuroki T, et al.: Prospective study of chemoprevention of hepatocellular carcinoma with Shosaiko- to (TJ-9) Cancer 1995, 76:743–749.

    Article  PubMed  CAS  Google Scholar 

  24. Rietveld A, Wiseman S: Antioxidant effects of tea: evidence from human clinical trials. J Nutr 2003, 133:3285S-3292S.

    PubMed  CAS  Google Scholar 

  25. Center SA: Metabolic antioxidant, nutraceutical, probiotic and herbal therapies relating to the management of hepatobiliary disorders. Vet Clin North Am Small Anim Pract 2004, 34:67–172.

    Article  PubMed  Google Scholar 

  26. Lucena MI, Andrale RJ, de la Cruz JP, et al.: Effects of silymarin MZ-80 on oxidative stress in patients with alcoholic cirrhosis. Int J Clin Pharmacol Ther 2002, 40:2–8.

    PubMed  CAS  Google Scholar 

  27. Kim NC, Graf TN, Sparacino CM, et al.: Complete isolation and characterization of silybins and isosilybins from milk thistle (Silybum marianum). Organic Biomol Chem 2003, 1:1648–1649.

    Google Scholar 

  28. Saller R, Meier R, Brignoli R: The use of silymarin in the treatment of liver diseases. Drugs 2001, 61:2035–2063.

    Article  PubMed  CAS  Google Scholar 

  29. Jacobs BP, Dennehy C, Ramirez G, et al.: Review: Milk thistle for the treatment of liver disease: a systematic review and meta-analysis. Am J Med 2002, 113:506–515.

    Article  PubMed  Google Scholar 

  30. Ferenci P, Dragosics B, Dittrich H, et al.: Randomised controlled trial of silymarin treatment in patients with cirrhosis of the liver. J. Hepatol 1989, 9:105–113.

    Article  PubMed  CAS  Google Scholar 

  31. Kumada H: Long term treatment of chronic hepatitis C with glycyrrhizin [Stronger Neo-Minophagen C (SNMC) for preventing liver cirrhosis and hepatocellular carcinoma. Oncology 2002, 62(Suppl 1):94–100.

    Article  PubMed  CAS  Google Scholar 

  32. Martin KW, Ernst E: Review: Antiviral agents from plants and herbs: a systematic review. Antiviral Ther 2003, 8:77–90.

    Google Scholar 

  33. Harrison SA, Torgerson S, Hayashi P, et al.: Vitamin E and vitamin C treatment improves fibrosis in patients with nonalcoholic steatohepatitis. Am J Gastroenterol 2003, 98:2486–2490.

    Google Scholar 

  34. Yang H, Sadda MR, Li M, et al.: S-adenosylmethionine and its metabolite induce apoptosis in HepG2 cells: role of protein phosphatase 1 and Bcl-xs. Hepatology 2004, 40:221–231.

    Article  PubMed  CAS  Google Scholar 

  35. De Silva HA, Saparamadu PAM, Thabrew MI, et al.: Liv.52 in alcoholic liver disease: a prospective, controlled trial. J Ethnopharmacol 2003, 84:47–50.

    Article  Google Scholar 

  36. Fan JG: Shanghai Multicentre Clinical Cooperative Group Of Danning Pian Trial: Evaluating the efficacy and safety of Danning Pian in the short term treatment of patients with non-alcohol fatty liver disease, a multicenter trial. Hepatobiliary Pancreat Dis Int 2004, 3:375–380.

    PubMed  Google Scholar 

  37. Liu JP, McIntosh H, Lin H. Chinese medicinal herbs for hepatitis B: a systematic review. Liver Int 2001, 21:280–286.

    Article  CAS  Google Scholar 

  38. Liu JP, Manheimer E, Tsutani K, Gludd C: Medicinal herbs for hepatitis C infection. Cochrane Database System Rev 2001, 4:CD003183.

    Google Scholar 

  39. Mabed M, El-Helw L, Shamaa S: Phase II study of Viscum fraxini-2 in patients with advanced hepatocellular carcinoma. Br J Cancer 2004, 90:65–69.

    Article  PubMed  CAS  Google Scholar 

  40. Stickel F, Brinkhaus B, Krahmer N, et al.: Antifibrotic properties of botanicals in chronic liver disease. Hepato-Gastroenterology 2002, 49:1102–1108.

    PubMed  CAS  Google Scholar 

  41. Wang B-E. Management of chronic hepatitis B: treatment of chronic liver disease with traditional Chinese medicine. J Gastroenterol Hepatol 2000, 15(Suppl):E67-E70.

    Article  PubMed  CAS  Google Scholar 

  42. Chan HL, Sung JJ, Fong WF, et al.: Double-blind placebo controlled study of Phyllanthus urinaris for treatment of chronic hepatitis B. Aliment Pharmacol Ther 2003, 18:339–345.

    Article  PubMed  Google Scholar 

  43. Li W, Wang C, Zhang J: Effects of Da Ding Feng Zhu decoction in 30 cases of liver fibrosis. J Trad Chinese Med 2003, 23:251–254.

    Google Scholar 

  44. Gao ZL, Gu XH, Cheng FT, Jiang FH: Effect of sea buckthorn on liver fibrosis: a clinical study. World J Gastroenterol 2003, 9:1615–1617.

    PubMed  Google Scholar 

  45. Jakkula M, Boucher TA, Beyendorff U, et al.: A randomized trial of Chinese herbal medicines for the treatment of symptomatic hepatitis C. Arch Intern Med 2004, 164:1341–1346.

    Article  PubMed  Google Scholar 

  46. Gunawan B, Kaplowitz N: Clinical perspectives on xenobioticinduced hepatoxicity. Drug Metab Rev 2004, 36:301–312.

    Article  PubMed  CAS  Google Scholar 

  47. Stewart MJ, Steenkamp V: Pyrrolizidine poisoning: a neglected area in human toxicology. Ther Drug Monit 2001, 23:698–708.

    Article  PubMed  CAS  Google Scholar 

  48. Pittler MH, Ernst E: Systematic review: hepatotoxic events associated with herbal medicinal products. Aliment Pharmacol Ther 2003, 18:451–471. This paper provides the laboratory, histologic, and clinical data related to cases of reported hepatotoxicity. The authors meticulously list concurrent medications alongside the reported hepatotoxic agent, which is relevant in judging probability of the herbal agent alone causing the hepatotoxicity.

    Article  PubMed  CAS  Google Scholar 

  49. Schiano TD: Hepatotoxicity and complementary and alternative medicines. Clin Liver Dis 2003, 7:453–473.

    Article  PubMed  Google Scholar 

  50. Stedman C: Herbal hepatotoxicity. Semin Liver Dis 2002, 22:195–206.

    Article  PubMed  CAS  Google Scholar 

  51. Anke J, Ramzan I: Kava hepatotoxicity: Are we any closer to the truth? Planta Med 2004, 70:193–196.

    Article  PubMed  CAS  Google Scholar 

  52. Whiting PW, Clouston A, Kerlin P: Black cohosh and other herbal remedies associated with acute hepatitis. Med J Aust 2002, 177:440–443.

    PubMed  Google Scholar 

  53. Thomsen M, Schmidt M: Hepatotoxicity from Cimicifuga racemosa? Recent Australian case report insufficiently substantiated. J Alt Complement Med 2003, 9:337–340.

    Article  Google Scholar 

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Batey, R.G., Salmond, S.J. & Bensoussan, A. Complementary and alternative medicine in the treatment of chronic liver disease. Curr Gastroenterol Rep 7, 63–70 (2005). https://doi.org/10.1007/s11894-005-0068-z

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