title: An updated systematic review with meta-analysis for the clinical evidence of silymarin.
abstract: BACKGROUND
  The potential benefit of silymarin (special extract from the fruits of Silybum marianum) in the treatment of liver diseases remains a controversial issue.
  
  
  METHODS
  For this systematic review electronic databases identified 65 papers for the search terms silymarin, silibinin, silicristin or milk thistle and clinical trial. Only 19 complied with the criteria'double-' or 'single-blind'. These publications were analysed from a clinical point of view and meta-analytic calculations were performed.
  
  
  RESULTS
  The clinical evidence ofa therapeutic effect of silymarin in toxic liver diseases is scarce. There is no evidence of a favourable influence on the evolution of viral hepatitis, particularly hepatitis C. In alcoholic liver disease, comparing with placebo, aspartate aminotransferase was reduced in the silymarin-treated groups (p = 0.01) while alkaline phosphatase was not. In liver cirrhosis, mostly alcoholic, total mortality was 16.1% with silymarin vs. 20.5% with placebo (n.s.); liver-related mortality was 10.0% with silymarin vs. 17.3% with placebo(p = 0.01).
  
  
  CONCLUSIONS
  Based on the available clinical evidence it can be concluded - concerning possible risks /probable benefits - that it is reasonable to employ silymarin as a supportive element in the therapy of Amanita phalloides poisoning but also (alcoholic and grade Child 'A') liver cirrhosis. A consistent research programme, consolidating existing evidence and exploring new potential uses,would be very welcome.
authors.affiliation: Institute of Complementary Medicine, Department of Internal Medicine, University Hospital Zurich, Switzerland. reinhard.saller@usz.ch
authors.forename: Reinhard
authors.initials: R
authors.lastname: Saller
authors.forename: Reto
authors.initials: R
authors.lastname: Brignoli
authors.forename: Jörg
authors.initials: J
authors.lastname: Melzer
authors.forename: Rémy
authors.initials: R
authors.lastname: Meier
mesh_terms: D000545:Amanita; D002986:Clinical Trials as Topic; D006526:Hepatitis C / Q000188:drug therapy; D006801:Humans; D007049:Iatrogenic Disease; D008107:Liver Diseases / Q000188:drug therapy; D012838:Silymarin / Q000493:pharmacokinetics / Q000627:therapeutic use*
chemical_list: D012838:Silymarin