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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

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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 < 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.

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Author information

Authors and Affiliations

  1. Department of Hepatology and Liver Transplant Medicine, PVS Memorial Hospital, Kochi, 682 025, India

    Cyriac Abby Philips

  2. Department of Pathology, PVS Memorial Hospital, Kochi, 682 025, India

    Rajaguru Paramaguru

  3. Sophisticated Test and Instrumentation Centre, Cochin University of Science and Technology, Kochi, 682 022, India

    Adarsh K. Joy

  4. Envirodesigns Eco Labs, Kochi, 682 025, India

    K. L. Antony

  5. Department of Gastroenterology, PVS Memorial Hospital, Kochi, 682 025, India

    Philip Augustine

Authors
  1. Cyriac Abby Philips
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  2. Rajaguru Paramaguru
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  3. Adarsh K. Joy
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  4. K. L. Antony
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  5. Philip Augustine
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Corresponding author

Correspondence to Cyriac Abby Philips.

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Conflict of interest

CAP, RP, AKJ, KLA, and PA declare that they have no conflict of interests.

Ethics statement

The authors declare that the study was performed in a manner to conform to the Helsinki Declaration of 1975, as revised in 2000 and 2008, concerning human and animal rights. The protocol was approved by the Institutional Ethics Committee and informed consent was obtained from the study subjects. The authors are responsible for the findings and the content of the paper.

Additional information

Parts of this study results were presented as Parallel Oral and Presidential Plenary at the American Association for the Study of Liver Diseases annual conference, The Liver Meeting, held at Washington D.C. on 22nd and 24th October 2017, respectively.

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Philips, C.A., Paramaguru, R., Joy, A.K. et al. Clinical outcomes, histopathological patterns, and chemical analysis of Ayurveda and herbal medicine associated with severe liver injury—A single-center experience from southern India. Indian J Gastroenterol 37, 9–17 (2018). https://doi.org/10.1007/s12664-017-0815-8

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  • DOI: https://doi.org/10.1007/s12664-017-0815-8

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