Case‐crossover study of hospitalization for acute hepatitis in Chinese herb users

Lee, Chang-Hsing; Wang, Jung‐Der; Chen, Pau‐Chung

doi:10.1111/j.1440-1746.2008.05511.x

Cited by 12 publications

(13 citation statements)

References 30 publications

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“…We recommend that physicians be alert for patients with both renal disease and chronic use of herbal products for oedema, constipation or losing weight; such patients should also be warned about the risks and their renal health monitored. In addition to nephrotoxicity, other studies have shown that chronic use of Chinese herbal drugs carries some risks of hepatotoxicity and congenital malformations 35 36. Chinese herbs are commonly used for pregnant women, children, cancer patients, the elderly and patients with chronic disease37–39 because it is believed that herbs are usually harmless.…”

Section: Discussionmentioning

confidence: 99%

Occupational kidney disease among Chinese herbalists exposed to herbs containing aristolochic acids

Yang

Wang

et al. 2010

Occup Environ Med

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ObjectiveMany Chinese herbs contain aristolochic acids (ALAs) which are nephrotoxic and carcinogenic. The objective of this study was to identify whether exposure to herbs containing ALAs increased the risk of kidney disease among Chinese herbalists.MethodsA nested case–control study was carried out on 6538 Chinese herbalists registered between 1985 and 1998. All incident cases of chronic renal failure reported to the Database of Catastrophic Illness of the National Health Insurance Bureau between 1995 and 2000 were defined as the case group. Up to four controls without renal failure were randomly matched to each case by sex and year of birth. A structured questionnaire survey was administered between November and December 2002. The Mantel–Haenszel method and conditional logistic regression were used to estimate the risks.Results40 cases and 98 matched controls were included in the final analysis. After adjusting for age, frequent analgesic use, and habitual consumption of alcohol, fermented or smoked food, we found manufacturing and selling Chinese herbal medicine (OR 3.43, 95% CI 1.16 to 10.19), processing, selling or dispensing herbal medicines containing Fangji (OR 4.17, 95% CI 1.36 to 12.81), living in the workplace (OR 3.14, 95% CI 1.11 to 8.84) and a history of taking of herbal medicines containing Fangji (frequently or occasionally) (OR 5.42, 95% CI 1.18 to 24.96) were significantly associated with renal failure.ConclusionOccupational exposure to and consumption of herbs containing ALAs increases the risk of renal failure in Chinese herbalists.

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Section: Discussionmentioning

confidence: 99%

Occupational kidney disease among Chinese herbalists exposed to herbs containing aristolochic acids

Yang

Wang

et al. 2010

Occup Environ Med

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“…Due to an increase in popularity of Chinese herbal medicine (CHM) regularly reimbursed under the National Health Insurance (NHI) system in Taiwan, Lee et al 7 followed some 200 000 randomly selected insurers from 1997 to 2002 to investigate the association of CHM intake with non-viral, non-alcoholic hepatitis. After adjustment for conventional hepatotoxic drug utilisation, the odds ratio (3.4, 95% CI 1.1 to 9.8) of developing acute hepatitis was increased for taking certain prescribed formulae containing Radix Paeoniae and Radix Glycyrrhizae.…”

Section: Discussionmentioning

confidence: 99%

Mortality and cancer incidence among physicians of traditional Chinese medicine: a 20-year national follow-up study

Liu

Liou

et al. 2010

Occup Environ Med

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“…The increases in T lymphocytes in lamina propria and IELs in PI-IBS and NI-IBS are not consistent among different studies – some reporting significant increases, while others reporting no change (Gwee et al, 1999; Spiller et al, 2000; Dunlop et al, 2003a; Lee et al, 2008). More importantly, one study found that the lamina propria T lymphocytes remained significantly elevated in patient controls (those who have enteritis, but do not develop PI-IBS) over healthy controls (Dunlop et al, 2003a).…”

Section: Altered Motility Function and Persistent Mucosal Inflammatiomentioning

confidence: 95%

“…Other studies noted similar increases in these immune cells and inflammatory mediators in the mucosa of IBS patients, who did not have a recent episode of enteritis (non-infectious/non-inflammatory IBS, NI-IBS. (Chadwick et al, 2002; Lee et al, 2008; Cremon et al, 2009). The suggestion was that this mucosal inflammation might account for motility dysfunction in IBS patients.…”

Section: Altered Motility Function and Persistent Mucosal Inflammatiomentioning

confidence: 99%

“…(3) Other studies found no significant increase in rectosigmoid mast cells or their products in the mucosal biopsies of PI-IBS and/or NI-IBS patients (Spiller et al, 2000; Chadwick et al, 2002; Dunlop et al, 2003c; Wang et al, 2004; Cenac et al, 2007; Klooker et al, 2010). Mast cell hyperplasia occurs in diarrhea-predominant PI-IBS patients, but not in constipation-predominant or alternating diarrhea/constipation patients – yet patients in all three types of IBS feel abdominal cramping (Lee et al, 2008). (4) Statistical correlation between two biological variables does not establish a cause and effect relationship between them.…”

Section: Mast Cell Hyperplasia and Visceral Hypersensitivity In Pi-ibmentioning

confidence: 99%

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Lessons Learnt from Post-Infectious IBS

Sarna

2011

Front. Physio.

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The development of IBS symptoms – altered bowel function and abdominal cramping in a subset of adult subjects exposed to severe enteric infections opened up an unprecedented opportunity to understand the etiology of this poorly understood disorder. Perhaps, for the reasons that these symptoms follow a severe enteric infection, and mucosal biopsy tissues are readily available, the focus of most studies thus far has been to show that mild/low-grade mucosal inflammation persisting after the initial infection has subsided causes the IBS symptoms. Parallel studies in non-infectious IBS patients, who did not have prior enteritis, showed similar mild mucosal inflammation. Together, these studies examined the mucosal infiltration of specific immune cells, increase of select inflammatory mediators, mast cell and enterochromaffin cell hyperplasia, and epithelial permeability. In spite of the fact that the data on these topics were not consistent among different studies and clinical trials with prednisone, fluoxetine, and ketotifen failed to provide relief of IBS symptoms, the predominant conclusions were that mild mucosal inflammation is the cause of IBS symptoms. However, the circular smooth muscle cells, and myenteric neurons are the primary regulators of gut motility function, while primary afferent neurons and CNS play essential roles in induction of visceral hypersensitivity – no explanation was provided as to how mild mucosal inflammation causes dysfunction in cells far removed. Accumulating evidence shows that mild mucosal inflammation in IBS patients is in physiological range. It has little deleterious effects on cells within its own environment and therefore it is unlikely to affect cells in the muscularis externa. This review discusses the disconnect between the focus on mild/low-grade mucosal inflammation and the potential mechanisms and molecular dysfunctions in smooth muscle cells, myenteric neurons, and primary afferent neurons that may underlie IBS symptoms.

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Case‐crossover study of hospitalization for acute hepatitis in Chinese herb users

Abstract: Chinese herbal users revealed a slightly increased risk of acute hepatitis. We therefore recommend pharmacovigilance and active surveillance for CHMs suspected with hepatotoxicity.

Cited by 12 publications

References 30 publications

Occupational kidney disease among Chinese herbalists exposed to herbs containing aristolochic acids

Occupational kidney disease among Chinese herbalists exposed to herbs containing aristolochic acids

Mortality and cancer incidence among physicians of traditional Chinese medicine: a 20-year national follow-up study

Lessons Learnt from Post-Infectious IBS

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