Trends of khat- related autoimmune hepatitis in Yemen

Background/Aims: Khat is a natural stimulant from the Catha Edulis' plant that is cultivated in Yemen and most of East African regions. It is widely used in Yemen as a pass time social habit. Chewing of this cursed plant's leaves has been shown to has a direct damaging effect on liver tissue. There are few case reports on the effect of Khat chewing and hepatitis, but this is a retrospective study to investigate this relationship in response to recent case reports from the UK and Australia. Our Aim: was to show the direct relation between the habit of Khat chewing in the region and autoimmune hepatitis (AIH). Methods: This is a retrospective study that analyzed 68 patients who were referred to a tertiary teaching hospital in Sana’a, Yemen, from January 2011 to December 2014 who were diagnosed as an acute autoimmune hepatitis based on serum biochemistry, immunoglobulins, autoantibodies and hepatic viral markers. Khat chewing habit was also recorded. Results: There were 68 patients in this study with mean age of 28.3 years (range: 15-60). Male (M) to female (F) ratio was 4:1. Khat chewers were accounted for 85% of patients. The age distribution showed typical bimodal distribution of type I auoimmune hepatitis. Liver enzymes' tests (ALT and AST) showed more than three fold's increase in 47% of patients. Seventy two percent of patients showed an elevation of Gamma (G)-globulin rate. Antinuclear antibodies (ANA) and smooth muscle antibodies (SMA) were positive in a high number of patients. Liver imaging did not reveal obstructive pathology. About 80% of the patients responded to the conventional medical treatment. Conclusions: This performed study clearly showed the high prevalence of autoimmune hepatitis among male Khat chewers with a change in the pattern of autoimmune hepatitis from the norms of the international F:M = 4:1 distribution to the F:M = 1:4 ratio. This is a clear index of the possibility of Khat, being a trigger factor of developing clinical and serologic features similar to that of idiopathic autoimmune hepatitis. Thus, public education as well as physician's awareness should be emphasized.