ACG Clinical Guideline: Diagnosis and Management of Idiosyncratic Drug-Induced Liver Injury

Idiosyncratic drug-induced liver injury (DILI) is common in gastroenterology and hepatology practices, and it can have multiple presentations, ranging from asymptomatic elevations in liver biochemistries to hepatocellular or cholestatic jaundice, liver failure, or chronic hepatitis. Antimicrobials,...

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Bibliographic Details
Published in:The American journal of gastroenterology Vol. 116; no. 5; pp. 878 - 898
Main Authors: Chalasani, Naga P., Maddur, Haripriya, Russo, Mark W., Wong, Robert J., Reddy, K. Rajender
Format: Journal Article
Language:English
Published: United States Wolters Kluwer 01.05.2021
Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins
Subjects:
Adrenal Cortex Hormones - therapeutic use
Alcohol
Biomarkers - analysis
Causality
Chemical and Drug Induced Liver Injury - diagnosis
Chemical and Drug Induced Liver Injury - therapy
Clinical medicine
Clinical trials
Comorbidity
Diabetes
Diagnosis, Differential
Dietary supplements
Disease Progression
Gastroenterology
Hepatitis
Humans
Liver
Liver failure
Liver Function Tests
Liver Transplantation
Nonsteroidal anti-inflammatory drugs
Prescription drugs
Referral and Consultation
Risk Factors
Womens health
ISSN:0002-9270, 1572-0241, 1572-0241
Online Access:Get full text
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Summary:Idiosyncratic drug-induced liver injury (DILI) is common in gastroenterology and hepatology practices, and it can have multiple presentations, ranging from asymptomatic elevations in liver biochemistries to hepatocellular or cholestatic jaundice, liver failure, or chronic hepatitis. Antimicrobials, herbal and dietary supplements, and anticancer therapeutics (e.g., tyrosine kinase inhibitors or immune-checkpoint inhibitors) are the most common classes of agents to cause DILI in the Western world. DILI is a diagnosis of exclusion, and thus, careful assessment for other etiologies of liver disease should be undertaken before establishing a diagnosis of DILI. Model for end-stage liver disease score and comorbidity burden are important determinants of mortality in patients presenting with suspected DILI. DILI carries a mortality rate up to 10% when hepatocellular jaundice is present. Patients with DILI who develop progressive jaundice with or without coagulopathy should be referred to a tertiary care center for specialized care, including consideration for potential liver transplantation. The role of systemic corticosteroids is controversial, but they may be administered when a liver injury event cannot be distinguished between autoimmune hepatitis or DILI or when a DILI event presents with prominent autoimmune hepatitis features.
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ISSN:0002-9270
1572-0241
1572-0241
DOI:10.14309/ajg.0000000000001259