What are the ACG guidelines for the diagnosis and management of drug-induced liver injury?

Updated: Jun 13, 2019
  • Author: Gagan K Sood, MD; Chief Editor: BS Anand, MD  more...
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American College of Gastroenterology guidelines for drug-induced liver injury

In 2014, the American College of Gastroenterology released new guidelines for the diagnosis and management of drug-induced liver injury. [38, 40] Key points include the following [38] :

  • Drug-induced liver injury is a diagnosis of exclusion; a thorough history-taking and workup should be performed to rule out other possible etiologies

  • Liver biopsy should be considered to help confirm the presence of drug-induced liver injury, if autoimmune hepatitis may be associated with the condition, and when immunosuppressive agents are being considered

  • The widely used Roussel Uclaf Causality Assessment Method (RUCAM) scale may underestimate the risk of liver injury associated with herbal and dietary supplements

These guidelines also include an algorithm for the diagnosis of patients with suspected drug-induced liver injury and provide separate diagnostic pathways based on the type of liver damage (hepatocellular, mixed, or cholestatic) present.

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