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

被引:99
作者
Andrade, Raul J.
Robles, Mercedes
Fernandez-Castaner, Alejandra
Lopez-Ortega, Susana
Lopez-Vega, M. Carmen
Lucena, M. Isabel
机构
[1] Univ Malaga, Virgen Victoria Hosp, Serv Gastroenterol, Liver Unit, E-29071 Malaga, Spain
[2] Univ Malaga, Sch Med, E-29071 Malaga, Spain
[3] Univ Malaga, Virgen Victoria Hosp, Pharmacol Serv, E-29071 Malaga, Spain
关键词
drug-induced hepatotoxicity; causality assessment; diagnostic algorithms; clinical scales;
D O I
10.3748/wjg.v13.i3.329
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Currently, pharmaceutical preparations are serious contributors to liver disease; hepatotoxicity ranking as the most frequent cause for acute liver failure and post-commercialization 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 fine-tuned as further information is collected. (c) 2007 The WJG Press. All rights reserved.
引用
收藏
页码:329 / 340
页数:12
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