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Bile Duct Injury Due to Drug-Induced Liver Injury

  • Drug-Induced Liver Injury (P Hayashi, Section Editor)
  • Published:
Current Hepatology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

Drug-induced liver injury (DILI) can present with a variable clinical and pathological phenotype and can be classified using liver enzymes as hepatocellular, cholestatic, or a mixed pattern. The cholestatic pattern has been considered amongst the spectrum of direct liver damage at the microscopic level, but recently, bile duct injury, as a manifestation of DILI, has emerged as a distinct entity, and this review examines several examples of biliary tract abnormalities due to DILI from a clinical, radiologic, and pathologic perspective.

Recent Findings

Case series and reports have emerged over the last few years of drugs causing cholangiographic changes or direct injury to the intra- and extra-hepatic biliary tree, such as ketamine and several chemotherapy agents. The DILI Network (DILIN) in the USA has published their experience of cases with vanishing bile duct syndrome on histology and sclerosing cholangitis-like changes seen on cholangiography. The pathogenesis of these changes is unclear but it appears that this type of injury is more severe and more likely to lead to a chronic injury with increased mortality than other cases of DILI.

Summary

Bile duct injury due to DILI is an increasingly recognized entity and imaging of the biliary tree in conjunction with liver biopsy should be considered in patients with severe cholestatic DILI.

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Abbreviations

ALT:

Alanine aminotransferase

Alk P:

Alkaline phosphatase

AST:

Aspartate aminotransferase

DILI:

Drug-induced liver injury

DILIN:

Drug-Induced Liver Injury Network

MRCP:

Magnetic resonance cholangiopancreatography

SC:

Sclerosing cholangitis

VBDS:

Vanishing bile duct syndrome

References

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Authors and Affiliations

  1. Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA

    Priya Grewal & Jawad Ahmad

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  1. Priya Grewal
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  2. Jawad Ahmad
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Contributions

All authors contributed to the collection of clinical data, data analysis, and initial and final drafting of the manuscript.

Corresponding author

Correspondence to Jawad Ahmad.

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Priya Grewal and Jawad Ahmad each declare no potential conflicts of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical Collection on Drug Induced Liver Injury

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Grewal, P., Ahmad, J. Bile Duct Injury Due to Drug-Induced Liver Injury. Curr Hepatology Rep 18, 269–273 (2019). https://doi.org/10.1007/s11901-019-00474-0

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  • DOI: https://doi.org/10.1007/s11901-019-00474-0

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