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Acute hepatitis and silymarin.

El-Kamary S, Shardell M, Abdel-Hamid M, Ismail S, El-Ateek M, Metwally M et al. 2009. A randomized controlled trial to assess the safety and efficacy of silymarin on symptoms, signs and biomarkers of acute hepatitis. Phytomed 16:5;391-400.

Acute hepatitis is an inflammatory liver condition ranging from mild flu like symptoms to fulminant disease. The most common cause is viral hepatitis causing a characteristic triad of impaired biliary excretion, heptocellular liver damage and systemic effects. As there is an absence of allopathic medication for the condition many turn to alternative therapies. Silybum marianum (St Mary's thistle) seeds have been used extensively in many parts of the world including Europe, Egypt and America. The primary active constituent isolated from the plant is silymarin, comprising silybin, isosilybin, silychristin and silydianin. It appears to prevent toxin entry into the hepatic cells, stimulating protein synthesis and regeneration of the hepatocytes; antioxidant activity and immune modulation.

There are few RCTs examining the use of silymarin in acute liver disease. This double blind randomised placebo controlled study included 105 symptomatic patients with alanine aminotransferase (ALT) levels more than 2.5 times the upper limit of normal, jaundice and [greater than or equal to] three other symptomatic criteria of less than one month. Participants received either placebo or silymarin 140 mg thrice daily for 4 weeks with primary outcome measures (bilirubin and hepatic enzymes) taken at baseline and again at 8 weeks.

After the treatment period the active group showed significantly faster resolution of impaired biliary excretion. The indirect bilrubin improved substantially. Other measures including indicators of heptocellular damage (liver enzymes) and the systemic effects of liver inflammation showed no significant differences. While not significant, the silymarin group did experience quicker resolution in fatigue, malaise and anorexia. No adverse effects were reported.

The authors suggest that more conclusive findings may be gathered in future trials with larger sample size, larger dose of active constituent and uniform causation for hepatitis. Overall evidence from the trial showed that 420 mg silymarin per day resulted in a trend towards improvement in clinical and subjective symptoms of acute hepatitis without corresponding declines in inflammatory biomarkers.

Tessa Finney-Brown MNHAA

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Author:Finney-Brown, Tessa
Publication:Australian Journal of Medical Herbalism
Geographic Code:8AUST
Date:Sep 22, 2009
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