Thread by @john_damianosMD

Drug-induced liver injury by @nagachalasani

@AmCollegeGastro #ACG2021 #LiverTwitter #Liver #GITwitter #DILI

Some cases!

Two flavors of DILI

🔺Intrinsic: intrinsically hepatotoxic (e.g., acetamionophen)

🔻Idiosyncratic: unpredictable ❔

DILI can manifest as all types of liver injury

🦹The most common culprits of DILI

⚠️Note how prevalent herbal/dietary supplement-induced DILI is

⚠️Caution with amox-clavulanate in patients with advanced #liver disease

DILI is a diagnosis of exclusion. Polypharmacy complicates identifying the causitive agent. And don't forget the viral hepatitides (including E) and autoimmune hepatitis

DILI from herbal/dietary supplements is ⬆️⬆️⬆️

⚠️Green tea extract is a common and growing culprit
⚠️Curcumin supplements (especially high bioavailability forms) have also been linked with DILI

Real case. Required liver transplant.

#naturaldoesnotequalhealthy

We really need to ask our patients about supplements and herbals.

✅Statins are SAFE in patients with underlying chronic #liver disease

DILI risk is ⬆️ in patients with chronic #liver disease

NAFLD and other chronic liver disease do ⬆️ DILI risk and are associated with WORSE DILI outcomes (3x higher risk of death)

We need to be very careful with prescribing in patients with CLD

Higher comorbidity burden is associated with increased risk of DILI mortality

Autoimmune-like DILI vs autoimmune hepatisis can be difficult to tease apart

DILI summary from @nagachalasani