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Un reto diagnóstico" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:8 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1303 "Ancho" => 1675 "Tamanyo" => 257795 ] ] "detalles" => array:1 [ 0 => array:3 [ "identificador" => "at0150" "detalle" => "Figure " "rol" => "short" ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Dysphagia megalatriensis and esophageal compression by cervical osteophyte. a) HRM showing pulsatile mid-esophageal hyperpressure (orange arrows) and secondary compartmentalised pressurisation (yellow arrow). b) TTE showing left atrial dilation. c) Barium swallow with double mid-esophageal compression phenomenon and narrowing (yellow arrow) by left atrium and cervical osteophyte (red arrowheads). d) Chest CT with contrast showing esophageal collapse due to extrinsic compression (red arrowheads).</p> <p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">L.A.: left atrium; C.O.: cervical osteophyte.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Raúl José Díaz Molina, Antonia Perelló Juan, Maria José Bosque López, Carmen Garrido Durán" "autores" => array:4 [ 0 => array:2 [ "nombre" => "Raúl José" "apellidos" => "Díaz Molina" ] 1 => array:2 [ "nombre" => "Antonia" "apellidos" => "Perelló Juan" ] 2 => array:2 [ "nombre" => "Maria José" "apellidos" => "Bosque López" ] 3 => array:2 [ "nombre" => "Carmen" "apellidos" => "Garrido Durán" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S0210570523004284" "doi" => "10.1016/j.gastrohep.2023.09.003" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0210570523004284?idApp=UINPBA00004N" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2444382424000634?idApp=UINPBA00004N" "url" => "/24443824/0000004700000003/v2_202405192000/S2444382424000634/v2_202405192000/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>" "titulo" => "Soy isoflavones treatment and increased transaminases" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "287" "paginaFinal" => "288" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "Marina Rovira-Illamola, Marta Navarro-González" "autores" => array:2 [ 0 => array:4 [ "nombre" => "Marina" "apellidos" => "Rovira-Illamola" "email" => array:1 [ 0 => "rovira@clinic.cat" ] "referencia" => array:3 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "Marta" "apellidos" => "Navarro-González" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de Farmacia, Hospital Clínic de Barcelona, Barcelona, Spain" "etiqueta" => "a" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Cap Comte Borrell, Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Barcelona, Spain" "etiqueta" => "b" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Tratamiento con isoflavonas de soja y elevación de transaminasas" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Menopause is a physiological event characterised by the loss of ovarian activity and the permanent end to menstruation. Vasomotor symptoms (hot flushes) associated with the menopause have been reported to affect more than 50% of perimenopausal women. Some choose to treat these symptoms with phytoestrogen-based products such as isoflavones.</p><p id="par0010" class="elsevierStylePara elsevierViewall">We present a case of elevated transaminases after taking Flavia nocta®, a dietary supplement based on soy isoflavones used for menopause.</p><p id="par0015" class="elsevierStylePara elsevierViewall">This was a 52-year-old woman, with a history of attention deficit disorder, with no other chronic diseases or obesity, who had the chance finding of abnormal transaminase results in a routine blood test: aspartate aminotransferase (AST) 55; alanine aminotransferase (ALT) 69; gamma-glutamyl transferase (GGT) 98; alkaline phosphatase (AP) 105. She was neither jaundiced nor otherwise symptomatic at the time. In a previous blood test, six months earlier, transaminase levels were normal: AST 26, ALT 18, GGT 24, AP 69. She had been on long-term treatment with atomoxetine for years with no change in the usual dosage. She was not taking any other drugs. The patient reported that she had started taking a menopausal dietary supplement two months earlier. She did not use any intoxicants or drink alcohol.</p><p id="par0020" class="elsevierStylePara elsevierViewall">She was advised to discontinue treatment with the food supplement. Coagulation, ferritin, ceruloplasmin and alpha-fetoprotein tests were performed; all were normal, and liver serologies (hepatitis B virus [HBV], hepatitis C virus [HCV], human immunodeficiency virus [HIV], Epstein–Barr virus [EBV] and cytomegalovirus [CMV]) were negative. A blood test was requested one month after discontinuation of the supplement and showed that her transaminase levels had returned to normal: AST 32, ALT 32, GGT 30, AP 82.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The increase in transaminase values was mild and did not meet the current international criteria for hepatotoxicity.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> The time sequence was compatible with taking Flavia Nocta®, both in terms of developing the adverse reaction after taking the food supplement and in the improvement after discontinuing it. Other causes of liver impairment were excluded (alcohol, drugs, viral or autoimmune hepatitis and metabolic diseases). The patient was taking atomoxetine, a drug which has rarely been associated with hepatotoxicity, but the prolonged duration of treatment without previous abnormalities makes it unlikely that this was the cause of the elevated liver enzymes. In addition, her transaminases returned to normal after withdrawal of the food supplement, without discontinuation of the atomoxetine therapy. For ethical reasons, re-administration of the food supplement to the patient was ruled out, so the effect of re-exposure could not be assessed.</p><p id="par0030" class="elsevierStylePara elsevierViewall">Flavia nocta® consists mainly of soy isoflavones (54.4<span class="elsevierStyleHsp" style=""></span>mg, minimum content 24.5<span class="elsevierStyleHsp" style=""></span>mg genistein and 16.3<span class="elsevierStyleHsp" style=""></span>mg daidzein), does not require a prescription, and is not financed by the National Health System here in Spain.</p><p id="par0035" class="elsevierStylePara elsevierViewall">Herbal products are perceived by the general population as safe and harmless. However, adverse effects associated with the use of herbal and dietary supplements have been reported. In the Spanish Hepatotoxicity Register, herbal products and dietary supplements were tenth on the list of therapeutic groups most responsible for hepatotoxicity from 1994 to 2006, ahead of analgesics, anxiolytics and antipsychotics.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">In a systematic review<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> which analysed 936 cases of herbal product-induced liver damage from 446 scientific publications, three were found to be associated with soy isoflavones. The first two in Spain were classified as probable cases of hepatocellular damage, one of jaundice associated with Fitosoja® and one of hypertransaminasaemia due to Biosoja®.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Another case in France developed asthenia and cytolytic hepatitis after administration of Inneov® Anti-age Fermeté.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The latency period ranged from one to two months, similar to ours.</p><p id="par0045" class="elsevierStylePara elsevierViewall">There is inconclusive evidence on the efficacy of phytoestrogen supplementation on vasomotor symptoms of menopause.<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> Although isoflavone-based products are considered safe according to the European Food Safety Authority (EFSA) 2015 report, they are not without their side effects. Women often take these products on their own initiative without telling their doctors. In cases of hepatotoxicity in peri- and post-menopausal women without other causes, the intake of isoflavone-based food supplements should be considered in the differential diagnosis.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Case definition and phenotype standardization in drug-induced liver injury" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G.P. Aithal" 1 => "P.B. Watkins" 2 => "R.J. Andrade" 3 => "D. Larrey" 4 => "M. Molokhia" 5 => "H. Takikawa" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1038/clpt.2011.58" "Revista" => array:6 [ "tituloSerie" => "Clin Pharmacol Ther" "fecha" => "2011" "volumen" => "89" "paginaInicial" => "806" "paginaFinal" => "815" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/21544079" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0010" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hepatotoxicidad secundaria a «productos naturales»: análisis de los casos notificados al Registro Español de Hepatoxicidad" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "M. García-Cortés" 1 => "Y. Borraz" 2 => "M.I. Lucena" 3 => "G. Peláez" 4 => "J. Salmerón" 5 => "M. Diago" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4321/s1130-01082008001100004" "Revista" => array:6 [ "tituloSerie" => "Rev Esp Enferm Dig" "fecha" => "2008" "volumen" => "100" "paginaInicial" => "688" "paginaFinal" => "695" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19159172" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0015" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Herb-induced liver injury: systematic review and meta-analysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "V.R. Ballotin" 1 => "L.G. Bigarella" 2 => "A.B.M. Brandão" 3 => "R.A. Balbinot" 4 => "S.S. Balbinot" 5 => "J. 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Hillaire-Buys" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1111/j.1472-8206.2010.00819.x" "Revista" => array:4 [ "tituloSerie" => "Fundam Clin Pharmacol" "fecha" => "2010" "volumen" => "24" "paginaInicial" => "90" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0025" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Phytoestrogens for menopausal vasomotor symptoms" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A. Lethaby" 1 => "J. Marjoribanks" 2 => "F. Kronenberg" 3 => "H. Roberts" 4 => "J. Eden" 5 => "J. Brown" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/14651858.CD001395.pub4" "Revista" => array:5 [ "tituloSerie" => "Cochrane Database Syst Rev" "fecha" => "2013" "volumen" => "2013" "paginaInicial" => "CD001395" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24323914" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/24443824/0000004700000003/v2_202405192000/S244438242400066X/v2_202405192000/en/main.assets" "Apartado" => array:4 [ "identificador" => "48445" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letter to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/24443824/0000004700000003/v2_202405192000/S244438242400066X/v2_202405192000/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S244438242400066X?idApp=UINPBA00004N" ]
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Vol. 47. Issue 3.
Pages 287-288 (March 2024)
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Vol. 47. Issue 3.
Pages 287-288 (March 2024)
Letter to the Editor
Soy isoflavones treatment and increased transaminases
Tratamiento con isoflavonas de soja y elevación de transaminasas
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