Secondary sclerosing cholangitis in patients with drug-induced liver injury.

Abstract

BACKGROUND:

Secondary sclerosing cholangitis has clinical features similar to primary sclerosing cholangitis but originates from a known pathological entity. Secondary sclerosing cholangitis has not been investigated in patients with drug-induced liver injury.

METHODS:

Overall 102 patients diagnosed with drug-induced liver injury were identified and magnetic resonance cholangiopancreatography images of 25 patients were reviewed.

RESULTS:

Ten patients (all females) out of 102 had confirmed features of secondary sclerosing cholangitis on biliary imaging. Overall 70% of patients with sclerosing cholangitis had jaundice vs. 25% without sclerosing cholangitis (p<0.01). All sclerosing cholangitis patients had cholestatic/mixed type of liver injury and compared with patients with cholestatic/mixed liver injury without confirmed abnormal MRCP (n=52), they also had more frequently jaundice, 70% vs. 23% (p=0.0065), higher peak alkaline phosphatase 551 (352-716) vs. 329 (202-543) (p=0.055) and longer time to resolution of liver injury 152 days (123-353) vs. 62 days (36-91) than patients without confirmed sclerosing cholangitis (p<0.0009).

CONCLUSIONS:

Our results indicate that drugs can lead to bile duct injury visualized on imaging. This should be a part of the differential diagnoses of secondary sclerosing cholangitis. These patients were more likely to present with jaundice and longer recovery of liver injury than other patients with cholestatic/mixed type of drug-induced liver injury.

• Authors: Hafsteinn O Gudnason, Helgi K Björnsson, Marianna Gardarsdottir, Hjalti M Thorisson, Sigurdur Olafsson, Ottar M Bergmann, Einar S Björnsson
• Journal: Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver (Dig Liver Dis) Vol. 47 Issue 6 Pg. 502-7 (Jun 2015) ISSN: 1878-3562 [Electronic] Netherlands
• PMID: 25840876 (Publication Type: Journal Article)
• Copyright: Copyright © 2015 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Topics

• Adult
• Aged
• Aged, 80 and over
• Chemical and Drug Induced Liver Injury (complications)
• Cholangiopancreatography, Magnetic Resonance
• Cholangitis, Sclerosing (diagnosis, etiology)
• Diagnosis, Differential
• Female
• Humans
• Male
• Middle Aged
• Retrospective Studies