Systematic Reviews
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jul 16, 2021; 9(20): 5490-5513
Published online Jul 16, 2021. doi: 10.12998/wjcc.v9.i20.5490
Herb-induced liver injury: Systematic review and meta-analysis
Vinícius Remus Ballotin, Lucas Goldmann Bigarella, Ajacio Bandeira de Mello Brandão, Raul Angelo Balbinot, Silvana Sartori Balbinot, Jonathan Soldera
Vinícius Remus Ballotin, Lucas Goldmann Bigarella, School of Medicine, Universidade de Caxias do Sul, Caxias do Sul 95070-560, RS, Brazil
Ajacio Bandeira de Mello Brandão, Post-Graduate Program in Medicine, Division of Hepatology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre 90050-110, RS, Brazil
Raul Angelo Balbinot, Silvana Sartori Balbinot, Jonathan Soldera, Department of Clinical Gastroenterology, Universidade de Caxias do Sul, Caxias do Sul 95070-560, RS, Brazil
Author contributions: All authors contributed to study concept and design and drafting of the manuscript; all authors contributed to acquisition of data, analysis, and interpretation of data; Ballotin VR contributed to statistical analysis; Soldera J contributed to study supervision; all authors contributed to critical revision of the manuscript for important intellectual content.
Conflict-of-interest statement: All authors have nothing to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jonathan Soldera, MD, MSc, Associate Professor, Staff Physician, Department of Clinical Gastroenterology, Universidade de Caxias do Sul, Rua Francisco Getúlio Vargas, 1130, Caxias do Sul 95070-560, RS, Brazil. jonathansoldera@gmail.com
Received: February 23, 2021
Peer-review started: February 23, 2021
First decision: March 28, 2021
Revised: April 3, 2021
Accepted: May 25, 2021
Article in press: May 25, 2021
Published online: July 16, 2021
Core Tip

Core Tip: The use of herbal supplements has been increasing in the last decades. Despite popular belief that natural products are harmless, they might cause herb-induced liver injury (HILI). This study aimed to identify herbal products associated with HILI. The search strategy retrieved 5918 references. In the final analysis, 446 references were included, with a total of 936 cases reported. We found 79 types of herbs related to HILI. Most of these patients had complete clinical recovery (82.8%). However, liver transplantation was necessary for 6.6% of these cases. Also, chronic liver disease and death were observed in 1.5% and 10.4%, respectively.