title: Hepatoportal sclerosis related to the use of herbals and nutritional supplements. Causality or coincidence?
abstract: Introduction and aim. Non-cirrhotic idiopathic portal hypertension (NCIPH), also known as hepatoportal sclerosis (HPS) is a disease of uncertain etiology. However, various pathophysiological mechanisms has been postulated, including chronic or recurrent infections and exposure to drugs or toxins. In this context, it appears to be of multifactorial etiology or resulting from a portal vascular endothelium aggression. It is important to consider whether the use of dietary supplements and herbs can trigger or contribute to the occurance of HPS. We report a possible association of HPS with the consumption of herbals and / or dietary supplements.
  
  
  METHODS
  We describe two cases of HPS in patients without known etiology causes associated with this disease.
  
  
  RESULTS
  Both patients were females who were diagnosed with HPS following the consumption of Herbalife® products and putative anorexigenic agents in the form herbals infusions. Image-based analysis and the assessment of the histopathological alterations found in the livers confirmed the diagnosis. The histopatological analysis of liver samples from both patients showed portal tracts enlarged by fibrosis with disappearance or reduction in the diameter of the portal vein branches. In many portal tracts, portal veins branches were replaced by aberrant thin-walled fendiforme vessels. The bile ducts and branches of the hepatic artery show normal aspects.
  
  
  CONCLUSIONS
  After the exclusion of other etiologic factors and a comprehensive analysis of clinical history, consumption of Herbalife® products and anorexigenic agents was pointed-out as a puttative predisposing factor for the development of the disease.
authors.affiliation: Federal University of Bahia, School of Medical Sciences, Salvador, Bahia, Brazil.
authors.forename: Fernanda Ferreira
authors.initials: FF
authors.lastname: Rios
authors.affiliation: Federal University of Bahia, School of Medical Sciences, Salvador, Bahia, Brazil.
authors.forename: Luiz Antônio
authors.initials: LA
authors.lastname: Rodrigues de Freitas
authors.affiliation: Professor University Hospital of the Federal University of Bahia, Salvador, Bahia, Brazil.
authors.forename: Liana
authors.initials: L
authors.lastname: Codes
authors.affiliation: Professor University Hospital of the Federal University of Bahia, Salvador, Bahia, Brazil.
authors.forename: Genario Oliveira
authors.initials: GO
authors.lastname: Santos Junior
authors.affiliation: Federal University of Bahia, School of Medical Sciences, Salvador, Bahia, Brazil.
authors.forename: Maria Isabel
authors.initials: MI
authors.lastname: Schinoni
authors.affiliation: Federal University of Bahia, School of Medical Sciences, Salvador, Bahia, Brazil.
authors.forename: Raymundo
authors.initials: R
authors.lastname: Paraná
mesh_terms: D000328:Adult; D001067:Appetite Depressants / Q000009:adverse effects*; D001706:Biopsy; D056486:Chemical and Drug Induced Liver Injury / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000139:chemically induced* / Q000175:diagnosis / Q000473:pathology; D008099:Liver / Q000098:blood supply / Q000187:drug effects* / Q000473:pathology; D008103:Liver Cirrhosis / Q000139:chemically induced* / Q000175:diagnosis / Q000473:pathology; D008875:Middle Aged; D010198:Pancytopenia / Q000139:chemically induced* / Q000175:diagnosis / Q000473:pathology; D028321:Plant Preparations / Q000009:adverse effects*; D011169:Portal Vein / Q000187:drug effects* / Q000473:pathology; D011237:Predictive Value of Tests; D012307:Risk Factors; D012598:Sclerosis; D013163:Splenomegaly / Q000139:chemically induced* / Q000175:diagnosis / Q000473:pathology; D000094724:Idiopathic Noncirrhotic Portal Hypertension
chemical_list: D001067:Appetite Depressants; D028321:Plant Preparations