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Herbal hepatotoxicity and WHO global introspection method.
Ann Hepatol 2013 Jan-Feb; 12(1):11-21AH

Abstract

Herbal hepatotoxicity is a rare but highly disputed disease because numerous confounding variables may complicate accurate causality assessment. Case evaluation is even more difficult when the WHO global introspection method (WHO method) is applied as diagnostic algorithm. This method lacks liver specificity, hepatotoxicity validation, and quantitative items, basic qualifications required for a sound evaluation of hepatotoxicity cases. Consequently, there are no data available for reliability, sensitivity, specificity, positive and negative predictive value. Its scope is also limited by the fact that it cannot discriminate between a positive and a negative causality attribution, thereby stimulating case overdiagnosing and overreporting. The WHO method ignores uncertainties regarding daily dose, temporal association, start, duration, and end of herbal use, time to onset of the adverse reaction, and course of liver values after herb discontinuation. Insufficiently considered or ignored are comedications, preexisting liver diseases, alternative explanations upon clinical assessment, and exclusion of infections by hepatitis A-C, cytomegalovirus (CMV), Epstein-Barr virus (EBV), herpes simplex virus (HSV), and varicella zoster virus (VZV). We clearly prefer as alternative the scale of CIOMS (Council for International Organizations of Medical Sciences) which is structured, quantitative, liver specific, and validated for hepatotoxicity. In conclusion, causality of herbal hepatotoxicity is best assessed by the liver specific CIOMS scale validated for hepatotoxicity rather than the obsolete WHO method that is liver unspecific and not validated for hepatotoxicity. CIOMS based assessments will ensure the correct diagnosis and exclude alternative diagnosis that may require other specific therapies.

Authors+Show Affiliations

Department of Internal Medicine II, Division of Gastroenterology and Hepatology, Klinikum Hanau, Academic Teaching Hospital of the Medical Faculty of the Goethe University Frankfurt, Main, Germany. rolf.teschke@gmx.deNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

23293189

Citation

Teschke, Rolf, et al. "Herbal Hepatotoxicity and WHO Global Introspection Method." Annals of Hepatology, vol. 12, no. 1, 2013, pp. 11-21.
Teschke R, Eickhoff A, Wolff A, et al. Herbal hepatotoxicity and WHO global introspection method. Ann Hepatol. 2013;12(1):11-21.
Teschke, R., Eickhoff, A., Wolff, A., Frenzel, C., & Schulze, J. (2013). Herbal hepatotoxicity and WHO global introspection method. Annals of Hepatology, 12(1), pp. 11-21.
Teschke R, et al. Herbal Hepatotoxicity and WHO Global Introspection Method. Ann Hepatol. 2013;12(1):11-21. PubMed PMID: 23293189.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Herbal hepatotoxicity and WHO global introspection method. AU - Teschke,Rolf, AU - Eickhoff,Axel, AU - Wolff,Albrecht, AU - Frenzel,Christian, AU - Schulze,Johannes, PY - 2013/1/8/entrez PY - 2013/1/8/pubmed PY - 2013/6/12/medline SP - 11 EP - 21 JF - Annals of hepatology JO - Ann Hepatol VL - 12 IS - 1 N2 - Herbal hepatotoxicity is a rare but highly disputed disease because numerous confounding variables may complicate accurate causality assessment. Case evaluation is even more difficult when the WHO global introspection method (WHO method) is applied as diagnostic algorithm. This method lacks liver specificity, hepatotoxicity validation, and quantitative items, basic qualifications required for a sound evaluation of hepatotoxicity cases. Consequently, there are no data available for reliability, sensitivity, specificity, positive and negative predictive value. Its scope is also limited by the fact that it cannot discriminate between a positive and a negative causality attribution, thereby stimulating case overdiagnosing and overreporting. The WHO method ignores uncertainties regarding daily dose, temporal association, start, duration, and end of herbal use, time to onset of the adverse reaction, and course of liver values after herb discontinuation. Insufficiently considered or ignored are comedications, preexisting liver diseases, alternative explanations upon clinical assessment, and exclusion of infections by hepatitis A-C, cytomegalovirus (CMV), Epstein-Barr virus (EBV), herpes simplex virus (HSV), and varicella zoster virus (VZV). We clearly prefer as alternative the scale of CIOMS (Council for International Organizations of Medical Sciences) which is structured, quantitative, liver specific, and validated for hepatotoxicity. In conclusion, causality of herbal hepatotoxicity is best assessed by the liver specific CIOMS scale validated for hepatotoxicity rather than the obsolete WHO method that is liver unspecific and not validated for hepatotoxicity. CIOMS based assessments will ensure the correct diagnosis and exclude alternative diagnosis that may require other specific therapies. SN - 1665-2681 UR - https://www.unboundmedicine.com/medline/citation/23293189/Herbal_hepatotoxicity_and_WHO_global_introspection_method_ L2 - https://linkinghub.elsevier.com/retrieve/pii/1026618 DB - PRIME DP - Unbound Medicine ER -