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Herbal and Non-Traditional Therapies for Viral Hepatitis

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Chronic Viral Hepatitis

Part of the book series: Clinical Gastroenterology ((CG))

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Abstract

Key Principles

Complementary alternative therapy is a growing market, estimated at $180 billion annually, with at least one-third of liver patients acknowledging their use.

Patients infected with hepatitis B and C account for the wide use of herbal and non-traditional therapies for viral hepatitis.

Silymarin is most commonly used for patients with liver disease. In hepatitis C patients, two small trials showed a benefit in the reduction of liver enzymes, without affecting the hepatitis C viral load. Other trials have demonstrated no difference in aminotransferase levels and no reported trial has noted an effect on viral clearance rates with silymarin administration.

In hepatitis B patients, silymarin showed potential benefit in some trials, but these results could not be reproduced. As such, silymarin, while safe, cannot be recommended for patients with hepatitis B or C.

Glycyrrhizin, the active constituent of glycyrrhiza, has showed some benefits in the treatment of those with chronic hepatitis C, with a reduction in aminotransferase levels noted in some trials. The side effect profile including hypokalemia and fluid retention approaching 20% of patients who receive this supplement cautions against its use.

Small trials using Phyllanthus amarus have suggested a higher clearance rate of serum HBsAg when given in combination with interferon. There is insufficient data to routinely recommend its use.

TJ-9 (Xiao-Chai-Hutang/Sho-Saiko-To) showed benefit in patients with chronic HBV with increased HBeAg seroconversion, as well as an improved survival rate in those with non-HBsAg-related cirrhosis at 5 years. Unfortunately, side effects including liver injury, autoimmune hepatitis, hypokalemia, and hypertension prohibit routine use of this medicine.

St. John’s wort (Hypericum perforatum) showed no efficacy in decreasing viral levels in chronic hepatitis C patients. Significant side effects associated with this medication suggest against its use in patients with liver disease.

Plantago Asiatic has shown preliminary promising results, suggesting suppression of hepatitis B DNA levels. More studies are required to recommend its use.

Herbal Medicine 861 showed promising initial results in patients with hepatitis B, reducing the level of liver fibrosis at the 6-month posttreatment interval. More studies will be required to verify this promising result.

CH 100 showed initial promise in decreasing ALT levels in patients with chronic hepatitis C, but these results were not verified by other studies. More data will be required for it to be recommended in patients with liver disease.

Liv 52 initially showed benefit in non-alcohol-related cirrhosis. However, in alcohol-related cirrhosis, a randomized, placebo-controlled trial showed increased mortality among the Child Class C patients, leading to the immediate withdrawal of the supplement from the United States.

The antioxidant N-acetyl cysteine (NAC) failed to show a benefit in patients with acute hepatitis A and B.

S-Adenosylmethionine use in patients with liver disease has also failed to show a consistent benefit.

Vitamin E may show benefit in those with chronic HBV infection though additional studies are required.

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Authors and Affiliations

  1. Indiana University School of Medicine, Indianapolis, IN, USA

    Veronika Gagovic & Paul Kwo

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  1. Veronika Gagovic
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  2. Paul Kwo
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Editors and Affiliations

  1. Department of Hepatology, Georgetown University Hospital, Reservoir Road GUH 3800, Washington, 20007, U.S.A.

    Kirti Shetty

  2. University of Connecticut Health Center, Farmington Ave. 236, Farmington, 06030-1845, U.S.A.

    George Y. Wu

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Gagovic, V., Kwo, P. (2009). Herbal and Non-Traditional Therapies for Viral Hepatitis. In: Shetty, K., Wu, G. (eds) Chronic Viral Hepatitis. Clinical Gastroenterology. Humana Press. https://doi.org/10.1007/978-1-59745-565-7_11

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  • DOI: https://doi.org/10.1007/978-1-59745-565-7_11

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