Assessment of drug-induced hepatotoxicity in clinical practice: A challenge for gastroenterologists

Abstract

Currently, pharmaceutical preparations are serious contributors to liver disease; hepatotoxicity ranking as the most frequent cause for acute liver failure and postcommercialization regulatory decisions. The diagnosis of hepatotoxicity remains a difficult task because of the lack of reliable markers for use in general clinical practice. To incriminate any given drug in an episode of liver dysfunction is a step-by-step process that requires a high degree of suspicion, compatible chronology, awareness of the drug's hepatotoxic potential, the exclusion of alternative causes of liver damage and the ability to detect the presence of subtle data that favors a toxic etiology. This process is time-consuming and the final result is frequently inaccurate. Diagnostic algorithms may add consistency to the diagnostic process by translating the suspicion into a quantitative score. Such scales are useful since they provide a framework that emphasizes the features that merit attention in cases of suspected hepatic adverse reaction as well. Current efforts in collecting bona fide cases of drug-induced hepatotoxicity will make refinements of existing scales feasible. It is now relatively easy to accommodate relevant data within the scoring system and to delete low-impact items. Efforts should also be directed toward the development of an abridged instrument for use in evaluating suspected drug-induced hepatotoxicity at the very beginning of the diagnosis and treatment process when clinical decisions need to be made. The instrument chosen would enable a confident diagnosis to be made on admission of the patient and treatment to be finetuned as further information is collected.

Clinical course and outcomes of drug-induced liver injury: Nimesulide as the first implicated medication

“…Many currently used drugs, particularly non-steroidal anti-inflammatory drugs (NSAIDs), are implicated in liver disorders, ranging from mild aminotransferases elevation to fulminant hepatitis with a high rate of mortality [1]. While most subjects with clinically mild disease are diagnosed on an outpatient basis, patients with a more severe course require hospital admission and, in some cases, are evaluated for orthotopic liver transplantation (OLT).…”

Valproic acid induced acute liver injury resulting in hepatic encephalopathy- a case report and literature review

“…As an essential part of adverse drug reaction (ADR), causality assessment was done using the Naranjo scale and RHUCAM score [23,24]. Naranjo scale concluded a definitive ADR with a score of 10 (> 9 is definitive) as shown in (Table 1).…”

Oral Amiodarone-induced liver Injury, especially Gamma Glutamyl Transferase Elevation: A Case Report

“…[5][6][7] We used the CIOMS/RUCAM scales to assess drug-induced liver injury and the result from the scale was "highly probably" adverse drug reaction (Scale score was 10 points). [17,18] Fonseca et al [1] reported that ALT, AST, and LDH levels were increased to more than 50 times in amiodarone-induced hepatitis because of amiodarone and that GGT and ALP levels were normal. However, there is no study in the literature on the possibility of isolated GGT elevation.…”