L'article donne les résultats d'une étude auprès de patients américains ayant subit une transplantation hépatique. 54% d'entre eux prenaient des produits hors prescription médicale : vitamines et/ou produits de phytothérapie ("herbal products"). Il détaille le cas de 3 patients atteints de CBP dont les taux étaient anormaux malgré le traitement. Ces patients prenaient des suppléments de vitamine E de leur propre initiative. Les taux sont redevenus normaux après arrêt de la vitamine E. L'auteur recommande aux médecins d'alerter leurs patients sur les risques encourus par la prise de vitamines ou d'autres produits parallèlement à leur traitement. Nombreux sont ceux qui ont une interaction avec le foie. Certains peuvent avoir un effet grave sur le traitement, ou compliquer considérablement le diagnostic de la maladie et l'évaluation de la pertinence du traitement.
Philippe
Synthèse de l'article en anglais :
The investigators deployed a questionnaire in their liver
transplant population to determine the extent of the patientsí
use of herbal remedies and vitamins. A total of 290 patients
(30.5%) completed the questionnaire, and 156 (54%) admitted
taking non-prescribed products. One hundred one patients
admitted taking only vitamins continuously, and 55 patients
were using vitamins and herbal remedies. Three patients with
primary biliary cirrhosis (PBC) had persistently elevated liver
enzymes, despite adequate immunosuppression, and in 1 case,
steroid pulses. On direct questioning, these patients eventually
admitted to taking high doses, of more than 1 gram per day,
of vitamin E (tocopherol). When the tocopherol was discontinued,
the liver enzymes gradually returned to normal after
4ñ8 weeks. As far as the herbal remedies were concerned, the
patient admitted to taking over 30 different types of remedy.
Of these, at least colostrum, echinacea, and noni juice were
associated with abnormal liver enzymes that returned to normal
with withdrawal of the remedy. In light of their findings,
the authors conclude that all transplant teams need to question
their patients directly and in detail as to whether they are
taking vitamins and /or herbal remedies, and to educate them
on the potential hazards. I would extend this to all physicians.