FEYZULLAH UÇMAK, Elif Tuğba TUNCEL, Hüseyin KAÇMAZ, Berat EBİK, Muhsin KAYA

Güneydoğu Anadolu Bölgesindeki Üçüncü Basamak Gastroenteroloji Kliniğinin Toksik Hepatit Deneyimi

Amaç: Toksik hepatit birçok ilaç ve bitkisel ürünün alınmasıyla ortaya çıkan klinik tablodur. Çok sayıda ilaç değişik mekanizmalarla toksik hepatite neden olmaktadır. Hastalığın görülme sıklığı ve sebepleri bölgesel farklılıklar gösterebilmektedir. Çalışmadaki amacımız kliniğimize başvuran toksik hepatitli olguların demografik, klinik ve laboratuar özelliklerini sunmaktır. Yöntemler: Ağustos 2014-Haziran 2016 tarihleri arasında kliniğimize anormal karaciğer fonksiyon testleri nedeniyle yatırılan, klinik ve laboratuar değerlendirme sonrası TH tanısı konulan hastalar alındı. Hastaların demografik özellikleri, toksik hepatitin muhtemel etiyolojisi, klinik özellikleri, biyokimya ve tam kan değerleri, klinik seyirleri kaydedildi. Bulgular: Çalışmaya yaş ortalaması 41.4±16.8 olan 56 (34 kadın) hasta alındı. Hastaların 31 (%55.6)’inde ilaçlar, 11 (%20.4)’inde bitkisel maddeler, 6 (%9,3)’ında narkotik madde ve 8 (%14,8)’inde bitkisel madde, ilaç ve narkotik kullanımına bağlı toksik hepatit geliştiği saptandı. İlaçlar içinde en çok antibiyotik (birinci sırada amoksisilin+ klavulanik asit) ve non-steroid anti inflamatuvar ilaç (birinci sırada diklofenak sodyum) kullanımı hikayesi saptandı. Bitkisel madde kullanımı olan hastalarda en sık meryem otu, lavanta çayı ve atom çayı kullanım hikayesi mevcuttu. Narkotik madde olarak en sık ekstazi (5 hasta) kullanımı saptandı. Otuz yaş altı (RR:1.545, p

Toxic hepatitis experience of the tertiary gastroenterological clinics in the Southeastern Anatolia

Objective: Toxic hepatitis is a clinical picture caused by the intake of many drugs and herbal products. Numerous drugs lead to toxic hepatitis through a variety of mechanisms. The prevalence and causes of the disease vary by regions. This study aims at presenting demographic, clinical and laboratory characteristics of toxic hepatitis cases that sought medical care at our clinics. Methods: This study comprises patients hospitalized at our clinics due to abnormal liver function tests and diagnosed with toxic hepatitis as a result of clinical and laboratory examinations between August 2014 and June 2016. The demographic characteristics of the patients, the potential etiology of the toxic hepatitis, clinical characteristics, biochemical and complete blood count results and the clinical course were recorded. Results: Fifty-six patients (34 women) with a mean age of 41.4±16.8 were included in this study. Toxic hepatitis was detected in 31 patients (55.6%) for use of drugs, 11 patients (20.4%) of herbal products, 6 patients (9.3%) of narcotic substances and 8 patients (14.8%) of herbal substances, drugs and narcotics. The most common drugs of all were antibiotics (amoxicillin + clavulanic acid ranking atop) and non-steroidal anti-inflammatory drugs (diclofenac sodium ranking atop). Patients with the use of herbal products commonly had a history of use for milk thistle, lavender tea and atom tea. The most common narcotic substance turned out to be ecstasy (5 patients). The age under thirty (RR: 1.545, p

PDF

___

Friis H, Andreasen PB. Drug-induced hepatic injury: an analysis of 1100 cases reported to the Danish Committee on Adverse Drug Reactions between 1978 and 1987. J Intern Med 1992; 232: 133–8.
Ibáñez L, Pérez E, Vidal X, Laporte JR, the Grup d’Estudi Multi- centric d’Hepatotoxicitat Aguda de Barcelona (GEMHAB). Pro- spective surveillance of acute serious liver disease unre-lated to infectious, obstructive, or metabolic diseases: epidemiological and clinical features, and exposure to drugs. J Hepatol 2002; 37:592–600
Sgro C, Clinard F, Ouazir K, et al. Incidence of drug-induced hepatic injuries: a French population-based study. Hepatology 2002; 36: 451–5.
Andrade RJ, Lucena MI. Drug-induced hepatotoxicity. N Engl J Med 2003; 349:1974–6.
National Institutes of Health (NIH) and LiverTox: Agents Included in LiverTox by Drug Class. Available online: https://livertox.nlm.nih.gov//Herbals_and_Dietary_Supplements.htm (accessed on 17 Octoberber 2017).
Strader DB, Seeff LB. Hepatotoxicity of herbal preparation. Chapter 37. In: Boyer TD, Wright TL, Manns MP, eds. Zakim and Boyer’s hepatology, a textbook of liver disease. 5th ed. Philadelphia, PA:Saunders-Elsevier, 2006: 551–60.
Seeff LB. Herbal hepatotoxicity. Clin Liver Dis 2007; 11:577–96.
Atayan Y, Çağın YF, Erdoğan MA, Harputluoglu MM, Bilgic Y. Ecstasy induced acute hepatic failure. Case reports. Acta Gastroenterol Belg. 2015 Jan-Mar; 78:53-5.
Guneysel O, Onur OE, Akoglu H, Denizbasi A. Ecstasy-induced recurrent toxic hepatitis in a young adult. Curr Ther Res Clin Exp. 2008 Jun; 69:260-5. doi: 10.1016/j.curtheres.2008.06.001
Arria AM, Yacoubian GS Jr, Fost E, Wish ED. The pediatric forum: Ecstasy use among club rave attendees. Arch Pediatr Adolesc Med. 2002; 156: 295-6.
Wu D, Otton SV, Inaba T, et al. Interactions of amphetamine analogs with human liver CYP2D6. BiochemPharmacol.1997; 53:1605-12.
Christophersen AS. Amphetamine designer drugs--an overviewand epidemiology. Toxicol-Lett. 2000;112-113:127-131
Ganey PE, Luyendyk JP, Maddox JF, et al. Adverse hepatic drug reactions: inflammatory episodes as consequence and contributor. Chem Biol Interact 2004; 150:35–51
Pillans PI. Drug associated hepatic reactions in New Zealand: 21 years experience. N Z Med J 1996; 109:315–9.
De Valle MB, Klinteberg VA, Alem N, et al. Drug induced liver injury in a Swedish Uni-versity Hospital out-patient hepatology clinic. Aliment Pharmacol Ther 2006;24:1187–95.
Andrade RJ, Lucena MI, Fernandez MC, et al. Drug induced liver injury: an analysis of 461 incidences submitted to the Spanish registry over a 10-year period. Gastroenterology 2005; 129:512–21.
Benichou C. Criteria of drug-induced liver disorders. Report of an international consensus meeting. J Hepatol 1990; 11:272–6.
Chalasani N, Bonkovsky HL, Fontana R, et al., United States Drug Induced Liver Injury Network. Features and Outcomes of 899 Patients With Drug-Induced Liver Injury: The DILIN Prospective Study. Gastroenterology. 2015; 148:1340-52. doi: 10.1053/j.gastro.2015; 03:006
Ostapowicz G, Fontana RJ, Schiødt FV, et al. Results of a prospective study of acute liver failure at 17 tertiary care centers in the United States. Ann Intern Med 2002; 137:947.
Zimmerman HJ. Drug-induced liver disease. Clin Liver Dis 2000; 4:73-96.
Chalasani N, Fontana RJ, Bonkovsky HL, et al. Causes, clinical features, and outcomes from a prospective study of drug-induced liver injury in the United States. Gastroenterology 2008; 135:1924-34. doi: 10.1053/j.gastro.2008; 09:011.
Bell LN, Chalasani N. Epidemiology of idiosyncratic drug-induced liver injury. Semin Liver Dis 2009; 29:337.
Teschke, R, Eickhoff, A. Herbal hepatotoxicity in traditional and modern medicine: Actual key issues and new encouraging steps. Front. Pharmacol. 2015; 6: 1–40.
Danan G, Teschke R. RUCAM in Drug and Herb Induced Liver Injury: The Update.Int J Mol Sci. 2015 Dec 24; 17(1). pii: E14. doi: 10.3390/ijms17010014.
Devarbhavi H, Bonkovsky HL, Russo M, Chalasani N. Drug-Induced Liver Injury. In: Sanyal A J, Boyer TD, Lindor KD, Terrault NA. editors. Zakim and Boyer’s Hepatology: A Textbook of Liver Disease . Seventh Edition. Elsevier: Philadelphia; 2018. P 844-890.