Practical guidelines for diagnosis and early management of drug-induced liver injury

The spectrum of drug-induced liver injury (DILI) is both diverse and complex. The first step in diagnosis is a suspicion of DILI based on careful consideration of recent comprehensive reports on the disease. There are some situations in which the suspicion of DILI is particularly strong. Exclusion o...

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Bibliographic Details
Published in:World journal of gastroenterology : WJG 2008-11, Vol.14 (44), p.6774-6785
Main Authors: Tajiri, Kazuto, Shimizu, Yukihiro
Format: Article
Language:English
Subjects:
Chemical and Drug Induced Liver Injury
Diagnosis, Differential
Early Diagnosis
Humans
Liver - drug effects
Liver - pathology
Liver Diseases - diagnosis
Liver Diseases - pathology
Liver Diseases - therapy
Liver Function Tests
Practice Guidelines as Topic
Review
Risk Factors
Severity of Illness Index
Treatment Outcome
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Summary:The spectrum of drug-induced liver injury (DILI) is both diverse and complex. The first step in diagnosis is a suspicion of DILI based on careful consideration of recent comprehensive reports on the disease. There are some situations in which the suspicion of DILI is particularly strong. Exclusion of other possible etiologies according to the pattern of liver injury is essential for the diagnosis. In patients with suspected DILI, diagnostic scales, such as the Councils for International Organizations of Medical Sciences/Roussel Uclaf Causality Assessment Method (CIOMS/RUCAM) scale, may be helpful for the final diagnosis. Early management of DILI involves prompt withdrawal of the drug suspected of being responsible, according to serum levels of alanine aminotransferase (ALT), alkaline phosphatase (ALP), and total bilirubin (T-Bil). However, as DILI patients may show resolution of liver injury without discontinuation of the drug, it should be carefully evaluated whether the suspected drug should be discontinued immediately with adequate consideration of the importance of the medication.
ISSN:1007-9327
DOI:10.3748/wjg.14.6774