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Bile Duct Injury due to Drug Induced Liver Injury.
1Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY 10029.
Current Hepatology Reports
|November 2, 2020
Summary
Drug-induced liver injury (DILI) can manifest as bile duct injury, a distinct entity. This review examines biliary tract abnormalities from DILI, highlighting its severity and potential for chronic damage.
Area of Science:
- Hepatology
- Gastroenterology
- Toxicology
Background:
- Drug-induced liver injury (DILI) presents with diverse clinical and pathological phenotypes, including hepatocellular, cholestatic, or mixed patterns.
- Cholestatic DILI has historically been viewed as direct microscopic liver damage, but bile duct injury is now recognized as a distinct manifestation.
Purpose of the Study:
- To review clinical, radiologic, and pathologic examples of biliary tract abnormalities resulting from DILI.
- To highlight the emergence of bile duct injury as a distinct entity within the spectrum of DILI.
Main Methods:
- Review of case series and reports on drugs causing cholangiographic changes or direct intra- and extra-hepatic biliary tree injury.
- Examination of DILI Network (DILIN) data on vanishing bile duct syndrome and sclerosing cholangitis-like changes.
Main Results:
- Emerging reports document drugs like ketamine and chemotherapy agents causing biliary tree injury.
- DILI Network cases show vanishing bile duct syndrome and sclerosing cholangitis-like changes.
- Bile duct injury from DILI appears more severe, with higher risk of chronic injury and mortality.
Conclusions:
- Bile duct injury is an increasingly recognized manifestation of DILI.
- Imaging of the biliary tree combined with liver biopsy is crucial for diagnosing severe cholestatic DILI.
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