Drug-induced cholestasis: causative agents and challenges in diagnosis and management
Drug-induced liver injury (DILI) is an adverse reaction to drugs and other xenobiotics that can have serious consequences and jeopardise progress in pharmacological therapy. While DILI is predominantly hepatocellular, a non-negligible percentage of patients who present with cholestatic damage. Mixed...
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| Format: | Article |
| Language: | English |
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Open Exploration Publishing Inc.
2023-09-01
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| Series: | Exploration of Digestive Diseases |
| Subjects: | |
| Online Access: | https://www.explorationpub.com/Journals/edd/Article/100527 |
| _version_ | 1797367904046415872 |
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| author | Jose M. Pinazo-Bandera Juan Pedro Toro-Ortiz Raúl J. Andrade Miren García-Cortés |
| author_facet | Jose M. Pinazo-Bandera Juan Pedro Toro-Ortiz Raúl J. Andrade Miren García-Cortés |
| author_sort | Jose M. Pinazo-Bandera |
| collection | DOAJ |
| description | Drug-induced liver injury (DILI) is an adverse reaction to drugs and other xenobiotics that can have serious consequences and jeopardise progress in pharmacological therapy. While DILI is predominantly hepatocellular, a non-negligible percentage of patients who present with cholestatic damage. Mixed damage is typically lumped together with cholestatic damage in the literature. Drug-induced cholestasis is often caused by the use of some non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics (i.e., amoxicillin-clavulanic acid), statins, and anabolic agents, among others. Drug-associated cholestasis tends to have a more chronic course and mostly affects older population. There is also a genetic predisposition to toxic cholestasis caused by some drugs (amoxicillin-clavulanic acid, statins, etc.). Recently, anatomical alterations of the biliary tract induced by drugs (especially immunotherapy drugs) have been described. Bile duct injury is one of the histopathological findings that have prognostic significance in DILI. A correct differential diagnosis with other causes of cholestasis is mandatory to reach an accurate diagnosis. Ursodexycholic acid, corticosteroids, and replacement therapies have been used as a therapeutic arsenal, although more evidence is needed to establish them as a routine therapeutic management in clinical practice. The breakthrough and validation of biomarkers of cholestasis and bile duct injury is an urgent need for drug development and post-marketing phase. |
| first_indexed | 2024-03-08T17:23:50Z |
| format | Article |
| id | doaj.art-8913248e32124acc9bfefeead2afcb91 |
| institution | Directory Open Access Journal |
| issn | 2833-6321 |
| language | English |
| last_indexed | 2024-03-08T17:23:50Z |
| publishDate | 2023-09-01 |
| publisher | Open Exploration Publishing Inc. |
| record_format | Article |
| series | Exploration of Digestive Diseases |
| spelling | doaj.art-8913248e32124acc9bfefeead2afcb912024-01-03T00:55:17ZengOpen Exploration Publishing Inc.Exploration of Digestive Diseases2833-63212023-09-012520222210.37349/edd.2023.00027Drug-induced cholestasis: causative agents and challenges in diagnosis and managementJose M. Pinazo-Bandera0https://orcid.org/0000-0002-8376-9573Juan Pedro Toro-Ortiz1https://orcid.org/0000-0002-1384-7193Raúl J. Andrade2https://orcid.org/0000-0002-1565-0757Miren García-Cortés3https://orcid.org/0000-0003-0410-8273Service of Gastroenterology and Hepatology, University Virgen de la Victoria Hospital, 29010 Málaga, Spain; Instituto de investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, University of Málaga, 29010 Málaga, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, SpainService of Gastroenterology and Hepatology, University Virgen de la Victoria Hospital, 29010 Málaga, SpainService of Gastroenterology and Hepatology, University Virgen de la Victoria Hospital, 29010 Málaga, Spain; Instituto de investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, University of Málaga, 29010 Málaga, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, SpainService of Gastroenterology and Hepatology, University Virgen de la Victoria Hospital, 29010 Málaga, Spain; Instituto de investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, University of Málaga, 29010 Málaga, Spain; Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, SpainDrug-induced liver injury (DILI) is an adverse reaction to drugs and other xenobiotics that can have serious consequences and jeopardise progress in pharmacological therapy. While DILI is predominantly hepatocellular, a non-negligible percentage of patients who present with cholestatic damage. Mixed damage is typically lumped together with cholestatic damage in the literature. Drug-induced cholestasis is often caused by the use of some non-steroidal anti-inflammatory drugs (NSAIDs), antibiotics (i.e., amoxicillin-clavulanic acid), statins, and anabolic agents, among others. Drug-associated cholestasis tends to have a more chronic course and mostly affects older population. There is also a genetic predisposition to toxic cholestasis caused by some drugs (amoxicillin-clavulanic acid, statins, etc.). Recently, anatomical alterations of the biliary tract induced by drugs (especially immunotherapy drugs) have been described. Bile duct injury is one of the histopathological findings that have prognostic significance in DILI. A correct differential diagnosis with other causes of cholestasis is mandatory to reach an accurate diagnosis. Ursodexycholic acid, corticosteroids, and replacement therapies have been used as a therapeutic arsenal, although more evidence is needed to establish them as a routine therapeutic management in clinical practice. The breakthrough and validation of biomarkers of cholestasis and bile duct injury is an urgent need for drug development and post-marketing phase.https://www.explorationpub.com/Journals/edd/Article/100527cholestatic drug-induced liver injuryhepatotoxicitydrug-induced cholestasis |
| spellingShingle | Jose M. Pinazo-Bandera Juan Pedro Toro-Ortiz Raúl J. Andrade Miren García-Cortés Drug-induced cholestasis: causative agents and challenges in diagnosis and management Exploration of Digestive Diseases cholestatic drug-induced liver injury hepatotoxicity drug-induced cholestasis |
| title | Drug-induced cholestasis: causative agents and challenges in diagnosis and management |
| title_full | Drug-induced cholestasis: causative agents and challenges in diagnosis and management |
| title_fullStr | Drug-induced cholestasis: causative agents and challenges in diagnosis and management |
| title_full_unstemmed | Drug-induced cholestasis: causative agents and challenges in diagnosis and management |
| title_short | Drug-induced cholestasis: causative agents and challenges in diagnosis and management |
| title_sort | drug induced cholestasis causative agents and challenges in diagnosis and management |
| topic | cholestatic drug-induced liver injury hepatotoxicity drug-induced cholestasis |
| url | https://www.explorationpub.com/Journals/edd/Article/100527 |
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