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Güneydoğu Anadolu Bölgesindeki Üçüncü Basamak Gastroenteroloji Kliniğinin Toksik Hepatit Deneyimi

Year 2018, Volume: 45 Issue: 2, 157 - 164, 15.06.2018
https://doi.org/10.5798/dicletip.425003

Abstract



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<0.001) ve
erkek cinsiyet (RR:11.0, p=0.013) narkotik madde kullanımı için risk faktörü
olarak saptandı.



Sonuç: Bölgemizde ilaç ve bitkisel madde kullanımına bağlı
gelişen TH anormal karaciğer fonksiyon testlerinin önemli bir sebebi olarak
dikkate alınmalıdır. Özellikle genç erkeklerde narkotik kullanımı toksik
hepatit etiyolojisinde önemli yer tutmaktadır.

References

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  • 2. 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.
  • 3. Teschke, R, Eickhoff, A. Herbal hepatotoxicity in traditional and modern medicine: Actual key issues and new encouraging steps. Front. Pharmacol. 2015; 6: 1–40.
  • 4. Bell LN, Chalasani N. Epidemiology of idiosyncratic drug-induced liver injury. Semin Liver Dis 2009; 29:337.
  • 5. 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.
  • 6. Zimmerman HJ. Drug-induced liver disease. Clin Liver Dis 2000; 4:73-96.
  • 7. 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.
  • 8. 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.
  • 9. Benichou C. Criteria of drug-induced liver disorders. Report of an international consensus meeting. J Hepatol 1990; 11:272–6.
  • 10. 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.
  • 11. 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.
  • 12. Pillans PI. Drug associated hepatic reactions in New Zealand: 21 years experience. N Z Med J 1996; 109:315–9.
  • 13. 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.
  • 14. Christophersen AS. Amphetamine designer drugs--an overviewand epidemiology. Toxicol-Lett. 2000;112-113:127-131.
  • 15. Wu D, Otton SV, Inaba T, et al. Interactions of amphetamine analogs with human liver CYP2D6. BiochemPharmacol.1997; 53:1605-12.
  • 16. 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.
  • 17. 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.
  • 18. 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.
  • 19. Seeff LB. Herbal hepatotoxicity. Clin Liver Dis 2007; 11:577–96.
  • 20. 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.
  • 21. 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).
  • 22. Andrade RJ, Lucena MI. Drug-induced hepatotoxicity. N Engl J Med 2003; 349:1974–6.
  • 23. Sgro C, Clinard F, Ouazir K, et al. Incidence of drug-induced hepatic injuries: a French population-based study. Hepatology 2002; 36: 451–5.
  • 24. 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.
  • 25. 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.
Year 2018, Volume: 45 Issue: 2, 157 - 164, 15.06.2018
https://doi.org/10.5798/dicletip.425003

Abstract

References

  • 1. 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.
  • 2. 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.
  • 3. Teschke, R, Eickhoff, A. Herbal hepatotoxicity in traditional and modern medicine: Actual key issues and new encouraging steps. Front. Pharmacol. 2015; 6: 1–40.
  • 4. Bell LN, Chalasani N. Epidemiology of idiosyncratic drug-induced liver injury. Semin Liver Dis 2009; 29:337.
  • 5. 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.
  • 6. Zimmerman HJ. Drug-induced liver disease. Clin Liver Dis 2000; 4:73-96.
  • 7. 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.
  • 8. 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.
  • 9. Benichou C. Criteria of drug-induced liver disorders. Report of an international consensus meeting. J Hepatol 1990; 11:272–6.
  • 10. 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.
  • 11. 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.
  • 12. Pillans PI. Drug associated hepatic reactions in New Zealand: 21 years experience. N Z Med J 1996; 109:315–9.
  • 13. 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.
  • 14. Christophersen AS. Amphetamine designer drugs--an overviewand epidemiology. Toxicol-Lett. 2000;112-113:127-131.
  • 15. Wu D, Otton SV, Inaba T, et al. Interactions of amphetamine analogs with human liver CYP2D6. BiochemPharmacol.1997; 53:1605-12.
  • 16. 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.
  • 17. 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.
  • 18. 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.
  • 19. Seeff LB. Herbal hepatotoxicity. Clin Liver Dis 2007; 11:577–96.
  • 20. 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.
  • 21. 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).
  • 22. Andrade RJ, Lucena MI. Drug-induced hepatotoxicity. N Engl J Med 2003; 349:1974–6.
  • 23. Sgro C, Clinard F, Ouazir K, et al. Incidence of drug-induced hepatic injuries: a French population-based study. Hepatology 2002; 36: 451–5.
  • 24. 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.
  • 25. 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.
There are 25 citations in total.

Details

Primary Language Turkish
Subjects Health Care Administration
Journal Section Research Articles
Authors

Feyzullah Uçmak 0000-0002-2677-3971

Elif Tuba Tuncel This is me 0000-0001-9547-9445

Hüseyin Kaçmaz This is me 0000-0001-6788-3459

Berat Ebik This is me 0000-0002-0012-2505

Muhsin Kaya This is me 0000-0002-7178-360X

Publication Date June 15, 2018
Submission Date May 18, 2018
Published in Issue Year 2018 Volume: 45 Issue: 2

Cite

APA Uçmak, F., Tuncel, E. T., Kaçmaz, H., Ebik, B., et al. (2018). Güneydoğu Anadolu Bölgesindeki Üçüncü Basamak Gastroenteroloji Kliniğinin Toksik Hepatit Deneyimi. Dicle Tıp Dergisi, 45(2), 157-164. https://doi.org/10.5798/dicletip.425003
AMA Uçmak F, Tuncel ET, Kaçmaz H, Ebik B, Kaya M. Güneydoğu Anadolu Bölgesindeki Üçüncü Basamak Gastroenteroloji Kliniğinin Toksik Hepatit Deneyimi. diclemedj. June 2018;45(2):157-164. doi:10.5798/dicletip.425003
Chicago Uçmak, Feyzullah, Elif Tuba Tuncel, Hüseyin Kaçmaz, Berat Ebik, and Muhsin Kaya. “Güneydoğu Anadolu Bölgesindeki Üçüncü Basamak Gastroenteroloji Kliniğinin Toksik Hepatit Deneyimi”. Dicle Tıp Dergisi 45, no. 2 (June 2018): 157-64. https://doi.org/10.5798/dicletip.425003.
EndNote Uçmak F, Tuncel ET, Kaçmaz H, Ebik B, Kaya M (June 1, 2018) Güneydoğu Anadolu Bölgesindeki Üçüncü Basamak Gastroenteroloji Kliniğinin Toksik Hepatit Deneyimi. Dicle Tıp Dergisi 45 2 157–164.
IEEE F. Uçmak, E. T. Tuncel, H. Kaçmaz, B. Ebik, and M. Kaya, “Güneydoğu Anadolu Bölgesindeki Üçüncü Basamak Gastroenteroloji Kliniğinin Toksik Hepatit Deneyimi”, diclemedj, vol. 45, no. 2, pp. 157–164, 2018, doi: 10.5798/dicletip.425003.
ISNAD Uçmak, Feyzullah et al. “Güneydoğu Anadolu Bölgesindeki Üçüncü Basamak Gastroenteroloji Kliniğinin Toksik Hepatit Deneyimi”. Dicle Tıp Dergisi 45/2 (June 2018), 157-164. https://doi.org/10.5798/dicletip.425003.
JAMA Uçmak F, Tuncel ET, Kaçmaz H, Ebik B, Kaya M. Güneydoğu Anadolu Bölgesindeki Üçüncü Basamak Gastroenteroloji Kliniğinin Toksik Hepatit Deneyimi. diclemedj. 2018;45:157–164.
MLA Uçmak, Feyzullah et al. “Güneydoğu Anadolu Bölgesindeki Üçüncü Basamak Gastroenteroloji Kliniğinin Toksik Hepatit Deneyimi”. Dicle Tıp Dergisi, vol. 45, no. 2, 2018, pp. 157-64, doi:10.5798/dicletip.425003.
Vancouver Uçmak F, Tuncel ET, Kaçmaz H, Ebik B, Kaya M. Güneydoğu Anadolu Bölgesindeki Üçüncü Basamak Gastroenteroloji Kliniğinin Toksik Hepatit Deneyimi. diclemedj. 2018;45(2):157-64.