A "bush tea" is an herbal medicine prepared from plants, fruits, bark, roots and/or flowers. Some plants used for bush teas contain toxins that can produce veno-occlusive disease (VOD) in the liver. It has been described worldwide, especially in the tropics and subtropics.


Plants implicated include:

(1) comfrey (Symphytum officinale)

(2) Crotalaria fulva (in West Indies)

(3) Senecio

(4) Heliotropium


Toxins involved: pyrrolizidine alkaloids


The disease can occur after a single cup of the brew if the dose of alkaloids is high enough.


The onset may be acute, subacute or chronic.


Acute veno-occlusive disease presents with:

(1) abdominal pain

(2) hepatomegaly

(3) nausea and vomiting


Chronic veno-occlusive disease presents with:

(1) hepatomegaly

(2) ascites and portal hypertension


Liver biopsy is required for the diagnosis. This shows fibrosis with narrowing and occlusion of central and sublobular hepatic veins.


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