Uncommon Presentations of Idiosyncratic Drug-Induced Liver Injury
AbstractPurpose of ReviewIdiosyncratic drug-induced liver injury (DILI) typically presents acutely with liver test abnormalities, sometimes with associated symptoms of abdominal pain, nausea, vomiting, jaundice, fevers, and rash. Histologic abnormalities in such cases of DILI typically range from lobular or portal hepatitis to hepatocyte necrosis. However, sometimes the drug-related liver injuries present with clinical and/or histological features atypical of garden variety DILI and they may be related to uncommon mechanisms of injury, histologic features, or clinical presentation.Recent FindingsMultiple agents or classes ...
Source: Current Hepatitis Reports - July 17, 2018 Category: Infectious Diseases Source Type: research
Drug-Induced Liver Injury in Children
AbstractPurpose of ReviewDrug-induced liver injury (DILI) is relatively rare among children but can cause substantial morbidity and mortality. Here, we summarize the literature on pediatric DILI including a focus on commonly used classes of drugs.Recent FindingsThe incidence of pediatric DILI remains poorly defined. Antimicrobials and antiepileptic medications are the most commonly reported causes of pediatric idiosyncratic DILI in the US DILI network (DILIN) experience. DILI among children being treated for cancer appears to be underreported, and recent literature clearly implicates newer classes of agents such as tumor n...
Source: Current Hepatitis Reports - July 14, 2018 Category: Infectious Diseases Source Type: research
DILI Associated with Skin Reactions
AbstractPurpose of ReviewAdverse drug reactions (ADR) frequently involve the liver and skin in the form of drug-induced liver injury or cutaneous drug eruption.Recent FindingsSkin ADR can range from harmless rash to severe skin manifestations such as drug rash with eosinophilia and systemic symptom syndrome (DRESS syndrome), Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and acute generalized exanthematous pustulosis (AGEP), all of which can be associated with severe outcome, including a 30% mortality rate in case of TEN. The association with co-occurring liver injury varies and in DRESS and SJS/TEN can ...
Source: Current Hepatitis Reports - July 12, 2018 Category: Infectious Diseases Source Type: research
Novel Approaches to Causality Adjudication in Drug-Induced Liver Disease
AbstractPurpose of ReviewDrug-induced liver injury (DILI) is a complex diagnosis dominantly based of exclusion.Recent FindingsCurrently available causality assessment instruments are considered to be suboptimal. Expert opinion appears to be best method to adjudicate causality, but is impractical to implement on a wide scale basis. Thus, new approaches are needed, for example, improving the specificity of current scoring systems. A further option would be to develop a system that utilizes computer-based scoring —which would reduce human error. Additionally, it would be ideal to have available drug-specific scoring systems...
Source: Current Hepatitis Reports - July 11, 2018 Category: Infectious Diseases Source Type: research
Beware of HCV and HEV in Patients with Suspected Drug-Induced Liver Injury
AbstractPurpose of ReviewWithout a specific biomarker, the diagnosis of drug-induced liver injury (DILI) relies on exclusion of other causes of liver injury. This review examines the importance of testing for hepatitis C (HCV) and hepatitis E (HEV) in patients with suspected DILI.Recent FindingsSeveral national DILI registries have reported HCV and HEV infection in patients initially diagnosed with DILI. Particularly in patients with suspected DILI who have acute hepatocellular liver injury, acute HCV and acute HEV infection should be considered even in the absence of traditional risk factors. For HCV infection, testing fo...
Source: Current Hepatitis Reports - July 11, 2018 Category: Infectious Diseases Source Type: research
Treatment of Gastro-Fundal Varices (Including a Discussion of BRTO)
AbstractPurpose of ReviewThe goal of our review is to provide a better understanding of the anatomy of gastric varices (GV) and to provide guidance regarding the management of bleeding GV.Recent FindingsDespite a paucity of head-to-head controlled data in this field, there remain no further advances in therapy. Alterations to previous techniques, such as combining EUS-guided metallic coil injection with cyanoacrylate injection or approaching endovascular therapies such as balloon-occluded retrograde transvenous obliteration (BRTO) via different pathways, have been developed but not studied in a comparative manner.SummaryTh...
Source: Current Hepatitis Reports - July 10, 2018 Category: Infectious Diseases Source Type: research
Innovative Care Models in Liver Disease: the Role of Multidisciplinary Teams
AbstractPurpose of ReviewPatients with chronic liver disease have diverse healthcare and psychosocial needs across a multitude of care domains. Incorporation of multidisciplinary teams (MDT) enhances care coordination between physician, patient, and other healthcare providers.Recent FindingsA MDT approach may be beneficial to provide comprehensive care for all cirrhotics. MDT are successfully used for management of hepatocellular carcinoma and evaluating candidacy for liver transplantation (LT). Among patients with alcoholic liver disease, lower rates of post LT recidivism are observed with MDT. The Practice Guide on Obesi...
Source: Current Hepatitis Reports - July 4, 2018 Category: Infectious Diseases Source Type: research
Long-Term Outcomes After Drug-Induced Liver Injury
AbstractPurpose of the ReviewThis review serves to update the reader on emerging data regarding a spectrum of drug-induced liver injury (DILI) outcomes that lie between complete resolution and acute liver failure. Such outcomes can range from mild chronic injury to late liver failure and mortality.Recent FindingsSeveral large registries are maturing with large numbers of DILI cases thus shedding light on outcomes including chronic injury and late fatality. We cover definitions commonly used to describe resolution versus chronic injury and mortality due to DILI. We look at rates of occurrence for these different outcomes in...
Source: Current Hepatitis Reports - July 2, 2018 Category: Infectious Diseases Source Type: research
Drug-induced Liver Injury Associated with Weight Loss Supplements
AbstractPurpose of ReviewTo highlight the current trends of weight loss supplement (WLS) use in the United States, detail their potential for drug-induced liver injury (DILI), identify specific compounds associated with hepatoxicity that are commonly found in WLS, and address ongoing diagnostic as well as treatment challenges.Recent FindingsThe regulatory nature of WLS exposes patients to a variety of potential healthcare pitfalls associated with WLS use. These include marketing claims with little supportive evidence, compound adulteration, and herb-drug interactions. While well-known historical cases have resulted in spec...
Source: Current Hepatitis Reports - June 21, 2018 Category: Infectious Diseases Source Type: research
Knowns and Unknowns: the Safety and Efficacy of Cancer Immunotherapy in Chronic Liver Disease
(Source: Current Hepatitis Reports)
Source: Current Hepatitis Reports - June 21, 2018 Category: Infectious Diseases Source Type: research
The Role of Anticoagulation in Treating Portal Hypertension
AbstractPurpose of ReviewTo revise experimental and clinical data supporting a less traditional role of anticoagulation for treating portal hypertension in patients with cirrhosis.Recent FindingsPortal hypertension is the main driver of complications such as ascites, variceal hemorrhage, and hepatic encephalopathy, with inflammation as a key component. The traditional view of cirrhosis as a pro-hemorrhagic condition has recently changed, prothrombotic complications being recognized as frequently as the hemorrhagic ones. Several data indicate a close relationship between inflammation, prothrombotic status, worsening of hepa...
Source: Current Hepatitis Reports - June 18, 2018 Category: Infectious Diseases Source Type: research
Drug-Induced Liver Injury: Understanding the Different Immune-Mediated Phenotypes and Clinical Management
AbstractPurpose of ReviewThe aim of this manuscript is to review two immune-mediated drug-induced liver injury (DILI) phenotypes, immune-allergic DILI (IA-DILI) and DILI with autoimmune hepatitis features (DILI-AIH), which are poorly defined and can lead to significant morbidity and mortality.Recent FindingsRecent information on this topic improves the understanding of IA-DILI and DILI-AIH regarding risk factors, associated medications, clinical presentations, histopathologic findings, and management strategies.SummaryAlthough the pathogenesis and specific mechanisms remain elusive, clinical and pathological advancements i...
Source: Current Hepatitis Reports - June 18, 2018 Category: Infectious Diseases Source Type: research
Extrahepatic Manifestations of Chronic Hepatitis B Infection
AbstractPurpose of ReviewHepatitis B virus (HBV) is responsible for over 350 million chronic carriers, 50% of whom will die prematurely from cirrhosis and hepatocellular carcinoma associated with T cell-mediated cytopathic immune clearance of the virus occurring over lifetime. Around 20% of acute and chronic HBV carriers are experiencing a great range of extrahepatic manifestations related to complex immunological mechanisms.Recent FindingsExtrahepatic manifestations are due to circulating immune complexes or possibly local inflammation triggered by viral antigens and activating the complement cascade. Their mechanism and ...
Source: Current Hepatitis Reports - June 13, 2018 Category: Infectious Diseases Source Type: research
Portal Hypertension Reverses Following Successful Antiviral Treatment for HCV: Fact or Fiction?
AbstractPurpose of ReviewThe development of portal hypertension has relevant implications in the natural history of patients with hepatitis C-related liver disease. Indeed, when the hepatic venous pressure gradient is ≥ 10 mmHg (clinical significant portal hypertension—CSPH), the risk of decompensation, hepatocellular carcinoma, or death markedly increases.Recent FindingsThe achievement of sustained virological response (SVR) has been associated with a reduction in portal pressure. The use of all-oral antiviral regimens allows treating patients with more advanced liver disease (CSPH or decompensated). However, curre...
Source: Current Hepatitis Reports - June 11, 2018 Category: Infectious Diseases Source Type: research
Is Exercise Beneficial and Safe in Patients with Cirrhosis and Portal Hypertension?
AbstractPurpose of ReviewIn spite of the many health benefits attributed to exercise, reports summarizing the literature in patients with cirrhosis are scarce. We aimed to provide a comprehensive review focusing on potential safety considerations in cirrhosis.Recent FindingsDiminished exercise capacity in patients with cirrhosis worsens their prognosis before and after liver transplantation. Exercise poses unique challenges in this population, raising questions of safety —worsening portal hypertension and malnutrition—and efficacy. In this review, we show that the balance of evidence supports supervised exercise progra...
Source: Current Hepatitis Reports - June 2, 2018 Category: Infectious Diseases Source Type: research
