Alternative explanations are common in about 47% of suspected drug-induced liver injury.

Researchers in Germany raised the question of whether a similar frequency might prevail in cases of assumed herb-induced liver injury.

First, the details.

• 23 articles comprised of 573 cases of initially suspected herb-induced liver injury were reviewed.

And, the results.

• Alternative causes were evident in 278 of 573 cases (49%) of assumed herb-induced liver injury.
  • Hepatitis by various viruses (10%)
  • Autoimmune diseases (10%)
  • Nonalcoholic and alcoholic liver diseases (5%)
  • Liver injury due to treatment with a drug or other herbal (44%)
  • Liver involvement in infectious diseases (5%)
• Biliary and pancreatic diseases were frequent alternative diagnoses (12%), raising potential treatment problems.
• Other diagnoses were rare.

The bottom line?

The authors concluded, “Thorough clinical evaluations and appropriate causality assessments [are needed] in future cases of suspected herb-induced liver injury.”

Even when herbal-related toxicity is suspected, a definitive diagnosis is difficult to establish without getting a detailed history of herbal use and proper analysis of the product or plant material.

Never be fooled into making a diagnosis involving herbals by default.

8/7/13 8:53 JR