Drug-Induced Liver Injury: Twenty Five Cases of Acute Hepatitis Following Ingestion of Polygonum multiflorum Thunb

• Published in: Gut and liver Vol. 5; no. 4; pp. 493 - 499
• Main Authors: Jung, Kyoung Ah, Min, Hyun Ju, Yoo, Seung Suk, Kim, Hong Jun, Choi, Su Nyoung, Ha, Chang Yoon, Kim, Hyun Jin, Kim, Tae Hyo, Jung, Woon Tae, Lee, Ok Jae, Lee, Jong Sil, Shim, Sang Goon
• Format: Journal Article
• Language: English
• Published: Korea (South) The Korean Society of Gastroenterology; the Korean Society of Gastrointestinal Endoscopy; the Korean Association for the Study of the Liver; the Korean Society of Neurogastroenterology and Motility; Korean Association for the Study of Intestinal Diseases; Korean College of Helicobacter and Upper Gastrointestinal Research; Korean Society of Pancreatobiliary Diseases 01.12.2011; Gastroenterology Council for Gut and Liver
• Subjects: drug induced liver injury; hepatotoxicity; Original; polygonum multiflorum thunb; Drug induced liver injury; Hepatotoxicity; Polygonum multiflorum Thunb
• ISSN: 1976-2283; 2005-1212; 2005-1212
• DOI: 10.5009/gnl.2011.5.4.493

Complementary medicines, including herbal preparations and nutritional supplements, are widely used without prescriptions. As a result, there has been growing interest in the risk of hepatotoxicity with these agents. It is difficult to determine causal relationships between these herbal preparations and hepatotoxicity. We report on 25 patients diagnosed with toxic hepatitis following ingestion of Polygonum multiflorum Thunb. Twenty-five patients (median age, 48 years [24 to 65 years]; M:F=18:7) with suspected P. multiflorum Thunb-induced liver injury were admitted to our hospital between 2007 and 2009. We analyzed clinical and histological data, including the types and the duration of P. multiflorum Thunb intake and the duration of hospital care. We also determined the type of liver injury using the R ratio (serum activity of ALT/serum activity of ALP). The types of complementary medicine used included tea (n=16), liquor (n=5), tea and liquor (n=2), powder (n=1), and honeyed pudding (n=1). The most common presenting sign was jaundice (76%), and 18 patients (72%) had evidence of hepatocellular liver injury. Histological findings were consistent with acute hepatitis in all cases (n=10) for which liver biopsy was performed. Twenty-three patients (91.6%) recovered with conservative management, 1 patient (4%) had a liver transplant, and 1 patient (4%) died of hepatic failure. In our cases, we found that P. multiflorum Thunb could be hepatotoxic and could lead to severe drug-induced liver injury, and even death.