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World J Gastroenterol. May 21, 2013; 19(19): 2864-2882
Published online May 21, 2013. doi: 10.3748/wjg.v19.i19.2864
Published online May 21, 2013. doi: 10.3748/wjg.v19.i19.2864
Herbal hepatotoxicity: Challenges and pitfalls of causality assessment methods
Rolf Teschke, Axel Eickhoff, Division of Gastroenterology and Hepatology, Department of Internal Medicine II, Klinikum Hanau, D-63450 Hanau, Germany
Rolf Teschke, Axel Eickhoff, Academic Teaching Hospital of the Medical Faculty, Johann Wolfgang Goethe-Universität Frankfurt am Main, D-60590 Frankfurt am Main, Germany
Christian Frenzel, Department of Medicine I, University Medical Center Hamburg Eppendorf, D-20246 Hamburg, Germany
Johannes Schulze, Institute of Industrial, Environmental and Social Medicine, Medical Faculty, Johann Wolfgang Goethe-Universität Frankfurt am Main, D-60590 Frankfurt am Main, Germany
Author contributions: All authors contributed equally to this work.
Correspondence to: Rolf Teschke, MD, Professor of Medicine, Division of Gastroenterology and Hepatology, Department of Internal Medicine II, Klinikum Hanau, Leimenstrasse 20, D-63450 Hanau, Germany. rolf.teschke@gmx.de
Telephone: +49-6181-21859 Fax: +49-6181-2964211
Received: February 21, 2013
Revised: April 11, 2013
Accepted: April 17, 2013
Published online: May 21, 2013
Revised: April 11, 2013
Accepted: April 17, 2013
Published online: May 21, 2013
Core Tip
Core tip: This review focuses on diagnostic causality assessment algorithms that have been used so far in herb induced liver injury (HILI) cases. Detailed information of the various methods with their strengths and weaknesses is provided including their challenges and pitfalls that emerged during the assessing course. For the physician caring for a patient with suspected HILI, the Council for International Organizations of Medical Sciences (CIOMS) scale is the preferred tool for assessing causality compared to numerous other causality assessment methods, which are inferior on various grounds. CIOMS based assessment should start at the day HILI is suspected to ensure completeness of clinical data.