Editorial
Copyright ©2007 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Jan 21, 2007; 13(3): 329-340
Published online Jan 21, 2007. doi: 10.3748/wjg.v13.i3.329
Assessment of drug-induced hepatotoxicity in clinical practice: A challenge for gastroenterologists
Raúl J Andrade, Mercedes Robles, Alejandra Fernández-Castañer, Susana López-Ortega, M Carmen López-Vega, M Isabel Lucena
Raúl J Andrade, Mercedes Robles, Alejandra Fernández-Castañer, Susana López-Ortega, M Carmen López-Vega, Liver Unit, Gastroenterology Service, “Virgen de la Victoria” University Hospital and School of Medicine, Málaga, Spain M Isabel Lucena, Clinical Pharmacology Service, “Virgen de la Victoria” University Hospital and School of Medicine, Málaga, Spain
Author contributions: All authors contributed equally to the work.
Correspondence to: Professor Raúl J Andrade, MD, PhD, Unidad de Hepatología, Departamento de Medicina, Facultad de Medicina, Boulevard Louis Pasteur 32, Málaga 29071, Spain. andrade@uma.es
Telephone: +34-952-134242 Fax: +34-952-131511
Received: August 24, 2006
Revised: October 8, 2006
Accepted: November 29, 2006
Published online: January 21, 2007
Abstract

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.

Keywords: Drug-induced hepatotoxicity; Causality assessment; Diagnostic algorithms; Clinical scales