Published online Jul 28, 2019. doi: 10.3748/wjg.v25.i28.3753
Peer-review started: March 18, 2019
First decision: May 24, 2019
Revised: June 5, 2019
Accepted: June 25, 2019
Article in press: June 26, 2019
Published online: July 28, 2019
Hepatic sinusoidal obstruction syndrome (HSOS) can be caused by the intake of pyrrolizidine alkaloids (PAs). To date, PAs-induced HSOS has not been extensively studied. In view of the difference in etiology of HSOS between the West and China, clinical profiles, imaging findings, treatment, and outcomes of HSOS associated with hematopoietic stem cell transplantation or oxaliplatin might be hardly extrapolated to PAs-induced HSOS. Reactive metabolites derived from PAs form pyrrole-protein adducts that result in toxic destruction of hepatic sinusoidal endothelial cells. PAs-induced HSOS typically manifests as painful hepatomegaly, ascites, and jaundice. Laboratory tests revealed abnormal liver function tests were observed in most of the patients with PAs-induced HSOS. In addition, contrast computed tomography and magnetic resonance imaging scan show that patients with PAs-induced HSOS have distinct imaging features, which reveal that radiological imaging provides an effective noninvasive method for the diagnosis of PAs-induced HSOS. Liver biopsy and histological examination showed that PAs-induced HSOS displayed distinct features in acute and chronic stages. Therapeutic strategies for PAs-induced HSOS include rigorous fluid management, anticoagulant therapy, glucocorticoids, transjugular intrahepatic portosystemic shunt, liver transplantation, etc. The aim of this review is to describe the pathogenesis, clinical profiles, diagnostic criteria, treatment, and outcomes of PAs-induced HSOS.
Core tip: Hepatic sinusoidal obstruction syndrome (HSOS), also named hepatic veno-occlusive disease, is a hepatic vascular disease presenting with abdominal distension, painful hepatomegaly, jaundice, and weight gain. The intake of pyrrolizidine alkaloids (PAs) is one of the major etiologies of HSOS in China. Unfortunately, PAs-induced HSOS has not been extensively studied up to now. Here, we describe the pathogenesis, clinical profiles, diagnosis, treatment, and outcomes of patients with PAs-induced HSOS.