Khat chewing and cirrhosis in Somaliland: Case series

BACKGROUND Khat chewing is common especially among men in East Africa and Yemen. It is generally viewed by the populace as a benign social custom. Several studies of ethnic Somali immigrants to Western countries suggest an association between khat chewing and hepatotoxicity, but the risk of hepatotoxicity related to khat chewing within African settings is not documented. AIM To identify and describe liver disease without evidence of alcohol exposure or infectious etiology in khat chewers. SETTINGS A university-affiliated teaching hospital in Somaliland. METHODS Cases of cirrhosis of unknown cause were identified from the clinical practice of Al Hayatt Hospital in Borama, Somaliland, during 14 months beginning December 2012. RESULTS Eight Somali men aged 27-70 years living in Somaliland were identified with cirrhosis of otherwise unknown cause. All chewed khat habitually for many years (15-128 bundles per day times years of use). A liver biopsy of one man was consistent with khat hepatotoxicity. Four of the eight men died during the study period. CONCLUSION Khat chewing may be associated with health consequences including severe hepatotoxicity with cirrhosis.