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

  title={ACG Clinical Guideline: The Diagnosis and Management of Idiosyncratic Drug-Induced Liver Injury},
  author={Naga P. Chalasani and Paul H. Hayashi and Herbert L. Bonkovsky and Victor J. Navarro and William M. Lee and Robert John Fontana},
  journal={The American Journal of Gastroenterology},
Idiosyncratic drug-induced liver injury (DILI) is a rare adverse drug reaction and it can lead to jaundice, liver failure, or even death. Antimicrobials and herbal and dietary supplements are among the most common therapeutic classes to cause DILI in the Western world. DILI is a diagnosis of exclusion and thus careful history taking and thorough work-up for competing etiologies are essential for its timely diagnosis. In this ACG Clinical Guideline, the authors present an evidence-based approach… 
ACG Clinical Guideline: Diagnosis and Management of Idiosyncratic Drug-Induced Liver Injury.
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.
EASL Clinical Practice Guidelines: Drug-induced liver injury.
CSH guidelines for the diagnosis and treatment of drug-induced liver injury
The CSH guidelines summarized the epidemiology, pathogenesis, pathology, and clinical manifestation and gives 16 evidence-based recommendations on diagnosis, differential diagnosis, treatment, and prevention of DILI.
Idiosyncratic Drug-Induced Acute Liver Failure: A Challenging and Distressing Scenario.
Careful history of drug taking and ruling out other competing etiologies is mandatory given that DILI can present with an extremely variable phenotype.
[Drug and herbal hepatotoxicity: an overview of clinical classifications].
The work summarizes the up to date information on diagnosis and mostly used classifications on DILI and RUCAM on drug induced liver toxicity.
Drug-induced liver injury: Asia Pacific Association of Study of Liver consensus guidelines
This APASL consensus guidelines on D ILI is a concise account of the various aspects including current evidence-based information on DILI with special emphasis on DilI due to antituberculosis agents and traditional and complementary medicine use in Asia.
Drug Induced Liver Injury: Review with a Focus on Genetic Factors, Tissue Diagnosis, and Treatment Options
The causative agents, clinical features, pathogenesis, diagnosis modalities, and outcomes of DILI are provided, and results of recently reported genetic studies and updates on pharmacological and invasive treatments are reviewed.
Drug-Induced Liver Injury: An Institutional Case Series and Review of Literature
This case report series demonstrates the importance of valproic acid, fluconazole, and amiodarone as potential hepatoxic agents of drug-induced liver injury leading to acute hepatic failure.
Drug-Induced Liver Injury
The framework for approaching DILI includes the following: categorize the injury as either intrinsic or idiosyncratic, establish time course and pattern of injury, and triage effectively to minimize mortality risk.
Azithromycin-Induced Liver Injury in an Asthma Exacerbation Patient With Autoimmune Features
A case of azithromycin-induced liver injury is presented in an asthma exacerbation patient with features of AIH, and a liver biopsy may be needed to differentiate between the two conditions.


Standardization of nomenclature and causality assessment in drug‐induced liver injury: Summary of a clinical research workshop
It was concluded that multicenter referral networks enrolling patients with suspected DILI according to standardized methodologies are needed and a web‐of‐knowledge database that provides concise, reliable, and updated information on cases of liver injury due to drugs and herbal and dietary supplements was established.
Causes, clinical features, and outcomes from a prospective study of drug-induced liver injury in the United States.
This report summarizes the causes, clinical features, and outcomes from the first 300 patients enrolled in a prospective study to recruit patients with suspected idiosyncratic drug-induced liver injury and create a repository of biological samples for analysis.
Risk factors for idiosyncratic drug-induced liver injury.
DILI is challenging to investigate because of its rarity, the lack of experimental models, the number of medications that might cause it, and challenges to diagnosis.
Characteristics of Idiosyncratic Drug-induced Liver Injury in Children: Results From the DILIN Prospective Study
Iiosyncratic DILI in children is most commonly caused by antimicrobial or central nervous system agents and usually presents with a hepatocellular injury pattern, but morbidity and infrequent mortality are seen.
Idiosyncratic drug hepatotoxicity
The current understanding of the pathophysiology of experimental drug hepatotoxicity is examined, focusing on acetaminophen, particularly with respect to the role of the innate immune system and control of cell-death pathways, which might provide targets for exploration and identification of risk factors and mechanisms in humans.
Important elements for the diagnosis of drug-induced liver injury.
Steroid and Ursodesoxycholic Acid Combination Therapy in Severe Drug-Induced Liver Injury
Treatment of severe DILI with corticosteroids (both pulse and step-down therapy) and UDCA appears to be safe, and leads to a more rapid reduction in bilirubin and transaminases after DILi.
Frequency, clinical presentation, and outcomes of drug‐induced liver injury after liver transplantation
  • Š. Šembera, C. Lammert, M. Charlton
  • Medicine
    Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
  • 2012
DILI is a rare yet underrecognized event among LT recipients, and the majority of cases are not clinically severe, and they resolve after drug cessation without hepatic retransplantation or death.
Etiology of New-Onset Jaundice: How Often Is It Caused by Idiosyncratic Drug-Induced Liver Injury in The United States?
Idiosyncratic DILI appears to be a rare cause of new-onset jaundice in a community hospital setting, and no mortality was observed at 6 wk in patients who developed idiosyncratic DilI.