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World J Gastroenterol. Dec 14, 2019; 25(46): 6704-6712
Published online Dec 14, 2019. doi: 10.3748/wjg.v25.i46.6704
Severe liver injury due to herbal and dietary supplements and the role of liver transplantation
Priya Grewal, Jawad Ahmad
Priya Grewal, Jawad Ahmad, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029, United States
Author contributions: All authors contributed to the collection of clinical data, data analysis, and initial and final drafting of the manuscript.
Conflict-of-interest statement: Authors declare no conflict of interests for this article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jawad Ahmad, FAASLD, FRCP (Hon), MD, Professor, Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, New York, NY10029, United States. jawad.ahmad@mountsinai.org
Telephone: +1-212-2418035 Fax: +1-212-7317340
Received: August 12, 2019
Peer-review started: August 12, 2019
First decision: September 10, 2019
Revised: November 26, 2019
Accepted: November 29, 2019
Article in press: November 29, 2019
Published online: December 14, 2019
Abstract

Herbal and dietary supplements (HDS) are increasingly used worldwide for numerous, mainly unproven health benefits. The HDS industry is poorly regulated compared to prescription medicines and most products are easily obtainable. Drug induced liver injury (DILI) is a well-recognized entity associated with prescription and over the counter medications and many reports have emerged of potential HDS-related DILI. There is considerable geographic variability in the risk and severity of DILI associated with HDS but the presentation of severe liver injury is similar with a hepatocellular pattern accompanied by jaundice. This type of injury can lead to acute liver failure and the need for liver transplantation. Patients will often fail to mention their use of HDS, considering it natural and therefore harmless. Hence physicians should understand that these products can be associated with DILI and explicitly ask about HDS use in any patient with otherwise unexplained acute liver injury.

Keywords: Herbal and dietary supplements, Drug induced liver injury, Liver transplantation, Acute liver failure, Geographic variability

Core tip: Herbal and dietary supplements (HDS) are used globally for their purported health benefits. Drug induced liver injury (DILI) is a well-recognized entity associated with all types of medications including HDS. There is considerable geographic variability in the use of HDS which is reflected in the risk of DILI associated with HDS. This article reviews severe liver injury due to HDS with an emphasis on geographic differences and injury requiring liver transplantation. Physicians should understand that HDS, despite being described as “natural” remedies and therefore assumed to be safe, can be associated with severe DILI.