Leroy Alice, Perrin Henri, Porret Raphael, Sempoux Christine, Chtioui Haithem, Fraga Montserrat, Bart Pierre-Alexandre
Service de Médecine interne, CHUV, Lausanne, Switzerland.
Service de Pathologie Clinique, CHUV, Lausanne, Switzerland.
Gastro Hep Adv. 2022 May 19;1(4):601-603. doi: 10.1016/j.gastha.2022.02.020. eCollection 2022.
Alternative medicines such as phytotherapy and herbal preparations have been widely used over the past 5 decades. However, they are still poorly known in Western medicine, and because they are considered as natural products, they are often omitted in the review of medication. One of the most used herbal preparations in Europe is Iberogast®, a formulation of 9 medicinal plant extracts, including Greater Celandine that has proven effective in the treatment of functional dyspepsia and irritable bowel syndrome. Safety and tolerability of Iberogast® were extensively evaluated in double-blind and randomized studies vs placebo, but rare and usually mild adverse symptoms have been reported in the literature. We report a 32-year-old female with no previous medical history who presented to the emergency department with abdominal pain, jaundice, and pruritus. The blood tests revealed an acute severe hepatitis with marked increase of direct bilirubin. After exclusion of other possible acute liver injury etiologies, we retained the diagnosis of Iberogast®-associated drug-induced liver injury. Patient's symptoms resolved spontaneously 5 weeks after treatment interruption. Despite the general safety of Iberogast®, occasional cases of drug-induced liver injury have been documented. Based on these observations, we recommend that the use of herbal and phytotherapeutic products should be part of the standard investigation of the medical history, as they could be relevant information in the diagnosis process of acute liver injury.
在过去的50年里，植物疗法和草药制剂等替代医学已被广泛使用。然而，它们在西医中仍然鲜为人知，而且由于它们被视为天然产品，在药物审查中常常被忽略。欧洲最常用的草药制剂之一是伊比罗格斯（Iberogast®），它是9种药用植物提取物的配方，其中包括白屈菜，已被证明对功能性消化不良和肠易激综合征有效。在与安慰剂对照的双盲随机研究中，对伊比罗格斯（Iberogast®）的安全性和耐受性进行了广泛评估，但文献中报道的不良反应症状罕见且通常较轻。我们报告了一名32岁、既往无病史的女性，她因腹痛、黄疸和瘙痒到急诊科就诊。血液检查显示为急性重症肝炎，直接胆红素显著升高。在排除其他可能的急性肝损伤病因后，我们确诊为伊比罗格斯（Iberogast®）相关药物性肝损伤。停药5周后患者症状自行缓解。尽管伊比罗格斯（Iberogast®）总体安全，但仍有药物性肝损伤的偶发病例记录在案。基于这些观察结果，我们建议草药和植物疗法产品的使用应作为病史标准调查的一部分，因为它们可能是急性肝损伤诊断过程中的相关信息。
