WHAT IS HEPATIC SARCOIDOSIS- CAUSES, SYMPTOMS & AYURVEDIC TREATMENT

Abstract

Sarcoidosis is a multisystem disease which has non-caseating granulomas found in the affected organs. The liver is the major organ of vertebrates and is helpful for the detoxification and synthesis of protein which is necessary for digestion and growth of the individual. The liver is the accessory organ for digestion which produces bile and is useful in the breakdown of fat. It is a dark reddish-brown colour with 2 lobe structures of unequal size and shape. Mainly the liver is connected by the large two vessels which have the hepatic artery and portal vein. These small blood vessels subdivide into small capillaries which are liver sinusoids and further lead to lobules. Sarcoidosis is a disease where there is a growth of tiny inflammatory cells in any part of the body. It can affect any part of the body’s organs such as the Liver, heart and lymph nodes. Liver involvement is most commonly found in patients with multisystem sarcoidosis. In this article, we are going to discuss its causes, symptoms and its ayurvedic aspect in detail. 

INTRODUCTION

Sarcoidosis in the hepatic site is most common and is seen in 70% of the patients, which involves pain in the upper quadrant which further leads to fatigue, Pruritus and jaundice which involves the liver. Portal hypertension (due to compression of the portal venules by granulomas which results in variceal bleeding) and Liver Cirrhosis links to long-term Hepatic Sarcoidosis. Sarcoidosis affects females more than males across all age groups and all ethnicity. Most of the patients rarely show any symptoms in the liver so known as an asymptomatic disease to some fulminant liver failure which requires transplantation of liver. Sarcoidosis is well known as Besnier- Boeck Schaumann disease which involves the abnormal collection of cells in the form of lumps which can affect every part of the organ such as the Heart, Brain, liver and eyes, small bowel.

Dermatological sarcoidosis is present as Erythema nodosum and lupus pernio, sometimes cardiomyopathy and parotid enlargement can be seen. The granuloma is formed by inflammation commonly by the immune system and made by the cluster of white blood cells which gets walled off from the rest of the body and the fibrous tissue feels hard and lumpy. It includes Giant cell inclusions and asteroid bodies, Schaumann bodies and some calcium oxalate crystals. The granulomatous lesion which is present in hepatic sarcoidosis is much small in size which can be seen with liver biopsy and occur in the portal and periportal zones of the hepatic sinuses which are well distributed in liver parenchyma which further gets converted into the hyalinized scar formation. 

EPIDEMIOLOGY OF SARCOIDOSIS

1. In sarcoidosis, the involvement of the liver is about 50-80%, whereas 10-30% are involved in abnormal enzymes of the liver.
2. The prevalence is estimated at 40:10,000 and young people are most affected.
3. More observed in North-European countries, the United States and Japan. 

PATHOGENESIS OF SARCOIDOSIS

1. It is multifactorial which involves immunological, genetic and environmental factors.  
2. The environmental trigger initiates the immune reactions which are present genetically.
3. The immune system T Helper 1 cells trigger by specific antigens which leads to the production of cytokine (tumor necrosis) which leads to aggregation of macrophage and the formation of granuloma.
4. Some antigens have been associated with sarcoidosis such as Leukocyte antigen A-1, B-8, DRB1 and DRB3 which have familial clusters of disease.
5. There are some postulated triggers of environment antigens which involve species of oxygen and various viruses (cytomegalovirus, retrovirus), with bacteria (Mycobacteria).  

SYMPTOMS AND SIGNS

1. Abnormality in the liver function test (LFTs) in 20-40% of the patients
2. Hepatosplenomegaly
3. Abdominal Pain stretches the Glisson’s Capsule and increases intrahepatic volume.
4. Weight loss
5. Night Sweats
6. Fever
7. Hepatic Encephalopathy
8. Jaundice
9. Pruritus
10. Ascites
11. Itchy skin
12. Arthralgias

DIAGNOSIS

1. Hepatic Function Test- It shows the elevated level of the Serum Alkaline phosphatase (ALP) and GGT (Gamma-glutamyl transpeptidase)
2. Biopsy of liver
3. CT Scan (Computed tomography)
4. MRI (Magnetic resonance imaging)

RARE CONDITIONS

In rare and chronic conditions, Liver Sarcoidosis includes-

1. Chronic Cholestasis
2. Portal Hypertension
3. Cirrhosis

1. Chronic Cholestasis

It is an advanced stage of hepatic Sarcoidosis which develops a chronic Cholestasis syndrome, where the bile cannot flow from the liver to the intestines.

The Mechanism of Cholestasis includes

1. Sarcoidosis of extrahepatic bile duct
2. Compression of the bile duct by the enlargement of the perihilar lymph node which involves the pancreas.
3. Primary liver cirrhosis and primary sclerosing cholangitis. 

Symptoms

1. Jaundice
2. Itchy skin
3. Malaise
4. Fever

Diagnosis

1. Liver function test

Treatment

1. Corticosteroids

2. Portal Hypertension

It is the increased blood pressure in veins around the liver. It is due to biliary fibrosis and cirrhosis. It is seen in advanced cases of patients.

Symptoms

1. Ascites (fluid in the abdomen)
2. Varices in the gastrointestinal tract

Diagnosis

1. Abdominal ultrasound and Upper GI endoscopy

Treatment

1. Diuretics and Beta Blockers

3. Liver Cirrhosis

Cirrhosis is the advanced stage (Scarring) of the liver which is permanent. It occurs in less than 1 % of liver sarcoidosis.

Symptoms

1. Fatigue
2. Confusion (hepatic encephalopathy)
3. Ascites
4. Itchy skin
5. Bleeding and bruising easily
6. Jaundice  

TREATMENT

1. Corticosteroids are the main line of treatment for systemic Sarcoidosis.  
2. Ursodeoxycholic Acid
3. Liver Transplantation is an option for patients with decompensated liver disease (ascites, hepatocellular carcinoma and variceal bleeding).

COMPLICATIONS OF SARCOIDOSIS

1. Damage to lungs- Shortness of breath, pulmonary fibrosis 
2. Damage to Kidney- Kidney failure, kidney stone, renal dysfunction  
3. Heart Affected- Abnormal rhythms of the heart
4. Nerve hampered- Paralysis
5. Joint Abnormalities
6. Cataract, Glaucoma

AYURVEDIC ASPECT

Ayurveda is a holistic medicine which treats the disease from its root cause and clears the symptoms and has a long history of success. According to Ayurveda, Sarcoidosis is correlated with Dhatughat Vikara and the deposition of Endotoxins (Ama) in the body. The accumulation of Ama (endotoxins) in the circulatory and lymphatic system, disturbs the immune system of the body and alters its functioning. This lacks cellular communication which gets covered with Ama and this Ama (endotoxins) leads to Low Agni (low digestive fire) and Low Ojas (Low immunity). So Ayurveda helps to restore the Agni and Ojas and Ayurvedic treatment reduces the chances of damage to tissues and prevents complications from fibrosis. Ayurveda also recommends the intake of medicinal herbs which strengthen the immunity to maintain overall health. A Sattvic diet has a crucial role.  

DOSHAS INVOLVED IN SARCOIDOSIS

1. This disease involves the lymph nodes and lymph nodes are due to Kapha doshas.
2. When Pitta Doshas start affecting the lymph nodes, they lose their nature which becomes hard.

CAUSATIVE FACTORS

• The vyadhikshamatwa varies from person to person
• It can also be due to Beejaswabhava (genetic factors)
• Prakriti is mainly determined in the early phase of the fetal period which occurs due to an unhealthy and unhygienic diet, depression and lack of exertion.
• Pitta and Rakta doshas can be vitiated by the excess intake of spicy, hot foods.

MANAGEMENT

1. Shodhan Chikitsa
2. Shaman Chikitsa

1. Shodhan Chikitsa

•  It involves the procedures such as Asthapana and Kashaya Basti
• Snehan (oleation externally and internally)
• Swedana (mild sudation therapy)
• Nasya (nasal instillation)
• Virechana (purgation therapy)
• Raktamokshan (bloodletting)   

2. Shamana Chikitsa

This is the palliative care which pacifies the tridoshas and this therapy uses medications in the form of Kashaya (ayurvedic drinks), Churna (powdered form), Vati (tablets) and Tailas (oil).

HERBS USEFUL FOR HEPATIC SARCOIDOSIS

1. AMLA– Amla (Emblica officinalis) is a powerhouse of nutrients and has many miraculous health benefits. It is helpful in keeping the skin healthy and strengthening the immune system of the body. Amla is useful in balancing tridoshas of the body and is useful in various skin diseases. Protects the body from various viral, bacterial infections. It is rich in antioxidants so useful in various liver health.
2. GUDUCHI- Guduchi (Tinospora cordifolia) is helpful in boosting the immune system and is useful in reducing the Ama (toxins) and various microbes which cause infections. Stimulates digestion and is useful in alleviating Vata and Kapha doshas, curing constipation and various bleeding disorders. Relieves a burning sensation in the body and is coolant in nature.
3. KALMEGH– Kalmegh (Andrographis paniculata) is a bitter tonic which is helpful in all respiratory tract infections. It is well known as an immune booster and has anti-inflammatory properties. Is helpful in expelling the vitiated pitta doshas and prevents the damage of liver cells which is caused by free radicals. Manages all types of liver-related disease and exhibits the hepatoprotective property as it has pitta balancing property.
4. NEEM- Neem (Azadirachta indica) has cooling properties which undergo proper digestion and absorption properties. Relieves Pitta doshas and is useful in cleansing and healing wounds quickly. Has Antiallergic and Anti-inflammatory properties so alleviates various skin disorders and relieves pain and swelling. It is well known as Liver Protectant and restores the level of liver enzymes.

HERBAL REMEDIES BY PLANET AYURVEDA FOR HEPATIC SARCOIDOSIS

Planet Ayurveda is a renowned GMP- Certified, ISO 9001:2015 certified US-FDA registered Ayurvedic Company which gets adhered to the main Aim of manufacturing various formulations as per the description in the Holistic System of Ayurveda. These products which are manufactured are made up of Pure herbs without any additives and preservatives without causing any side effects on the human body. Planet Ayurveda provides many herbal supplements for treating various health-related problems. For Hepatic Sarcoidosis Planet Ayurveda provides various supplements which are helpful without causing any side effects.

PRODUCTS LIST

1. KANCHNAAR GUGGUL
2. BOSWELLIA CURCUMIN
3. LIVER DETOX FORMULA
4. PHYLLANTHUS NIRURI
5. KALMEGH GHAN VATI
6. YAKRIT PLIHANTAK CHURNA

PRODUCTS DESCRIPTION

1. Kanchnaar Guggul

Kanchnaar Guggul is a herbal tablet which is formulated by planet ayurveda using Kanchnar Bark (Bauhinia variegata), Amalaki (Emblica officinalis), Guggul (Commiphora mukul) and Varuna Bark (Crataeva religiosa) and more. It is helpful in reducing swelling and removing toxins from the body. Possess anti-inflammatory properties and maintain the accumulated kapha in the body channels.

Dosage– 2 tablets twice daily after meals with plain water

2. Boswellia Curcumin

Boswellia Curcumin is a polyherbal Capsules formulation which is made by planet ayurveda using Shallaki (Boswellia serrata) and Curcumin (Curcuma longa). It is helpful in maintaining overall health and maintaining healthy joints. It Relieves morning stiffness and reduces the oedema of the brain.

Dosage- 1 capsule twice daily after meals with plain water

3. Liver Detox Formula

Liver Detox Formula from planet ayurveda is a polyherbal capsule from planet ayurveda which consists of ingredients such as Himsra (Capparis spinosa), Kasni (Cichorium intybus), Jhavuka (Tamarix gallica) and many more. It is helpful in maintaining a healthy liver and supports a healthy digestive system. Clears the toxins from the body and improves the good texture of the skin which provides a glow on the face.

Dosage- 1 capsule twice daily after meals with plain water

4. Phyllanthus Niruri

Phyllanthus Niruri is a single herbal capsule which is manufactured by planet Ayurveda using Bhumi Amla (Phyllanthus Niruri). It is helpful in maintaining a healthy urinary system and has laxative properties which is working as a liver stimulant. Has mild Diuretic properties and is beneficial in gastrointestinal ailments.

Dosage- 1 capsule twice daily after meals with plain water

5. Kalmegh Ghan Vati

Kalmegh Ghan Vati are herbal tablet formulations made by planet Ayurveda that contain Kalmegh (Andrographis paniculata). It is helpful in maintaining liver ailments and promotes the detoxification of the liver with blood purifications. Due to its bitter taste, it lowers the blood sugar levels in the body. Improves the digestive fire and boosts the immune system.

Dosage– 2 tablets twice daily after meals with plain water.

6. Yakrit Plihantak Churna

Yakrit Plihantak Churna is a blend of powder that it is a Polyherbal Churna formulated by planet ayurveda using Bhumi Amla (Phyllanthus Niruri), Kaasni (Cichorium intybus), Sharpunkha (Tephrosia purpurea) and many more. It is helpful in reducing the excess stored fat from the liver and eliminates toxins from the liver. Supports healthy liver and spleen. Regenerate the cells of the liver and relieve inflammation.

Dosage– 1 teaspoon twice daily after meals with plain water.

CONCLUSION

Sarcoidosis is a multisystem disease which has non-caseating granulomas found in the affected organs. The liver is the major organ of vertebrates and is helpful for the detoxification and synthesis of protein which is necessary for digestion and growth of the individual. Sarcoidosis in the hepatic site is most common and is seen in 70% of the patients, which involves pain in the upper quadrant which further leads to fatigue, Pruritus and jaundice which involves the liver. According to Ayurveda, Sarcoidosis is correlated with Dhatughat Vikara and the deposition of Endotoxins (Ama) in the body.  For Hepatic Sarcoidos is Planet Ayurveda provides various supplements which are helpful without causing any side effects.