ACG Updates Drug-Induced Liver Injury Guidelines

The American College of Gastroenterology has updated it guidelines on Diagnosis and Management of Idiosyncratic Drug-Induced Liver Injury (DILI).

To create the guidelines, the writing group used data from a review and analysis of recent literature, the American College of Physicians’ Manual for Assessing Health Practices and Designing Practice Guidelines, ACG guideline policies, and the clinical experience of the authors and reviewers. It serves as an update to the group’s 2014 guidelines.

The recommendations detail diagnostic methods for individuals with suspected hepatocellular or mixed DILI, as well as those with suspected cholestatic DILI. Also among the recommendations:

• Liver biopsy is recommended if there is an unrelenting rise in liver biochemistries or a sign of worsening liver function.
• Reexposure to a drug thought to have caused hepatotoxicity is strongly recommended against.
• Treatment with suspected agents should be stopped promptly in individuals with suspected DILI.
• Consider NAC treatment in adults with erly stage ALF.
• NAC should not be used in children with severe DILI leading to ALF.

The full list of guidelines is available from the ACG.

—Michael Potts

Chalasani NP, Maddur H, Russo MW, et al. ACG clinical guideline: diagnosis and management of idiosyncratic drug-induced liver injury. AJG. 2021;116(5):878-898. doi: 10.14309/ajg.0000000000001259.