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Printable Handouts
Navigable Slide Index
- Introduction
- DILI topics to be discussed
- Rising incidence of herbal and dietary supplement (HDS) hepatotoxicity
- Increasing trend of HDS causing DILI in the US DILIN registry
- Increasing trend of HDS and anabolic androgenic steroids in Spain
- Problems with diagnosing HILI/HDS liver injury
- Mechanisms of HDS hepatotoxicity
- Common herbal products and their possible hepatotoxic components
- The DILIN HDS classification scheme
- Herbals removed from the market due to hepatotoxicity
- FDA regulation of HDS
- Claims for dietary supplements and drugs
- EU regulations on HDS
- Is green tea hepatotoxic?
- Catechins – what are they and why should you care?
- Mislabelling of herbals
- Clinical features of HDS in US DILIN _x000B_and Spanish registries
- DILI: still a diagnosis of exclusion
- Issues in diagnosing DILI
- Determining clinical signatures of DILI
- Diagnosing DILI: how to interpret liver tests and injury patterns
- Interpreting liver injury patterns (R values)
- Causality assessment methods to diagnose DILI
- Roussel Uclaf Causality Assessment Method (RUCAM/CIOMS)
- Scoring hepatocellular injury using RUCAM
- Limitations of RUCAM
- Histopathology: part of a clinical signature of DILI Agents
- Histology of DILI
- DILI network causality assessment
- Need to exclude other liver injury causes
- When acute DILI isn’t
- Published case reports of DILI often lack crucial details
- ACG Clinical Guideline
- ACG clinical guidelines on diagnosing and managing DILI
- Treatment of DILI
- Preventing DILI
- Acetaminophen: can ODs be prevented?
- Drug liver biochemistry monitoring recommended
- Typical acute hepatocellular DILI leading to death
- LiverTox.nih.gov a website on drug-induced liver injury
- Categories of evidence in LiverTox for drugs causing DILI
- LiverTox update
- The future of DILI
Topics Covered
- Herbal and dietary supplements (HDS) and their hepatotoxicity
- Problems with diagnosing HDS liver injury
- Regulations and market-removed products
- Catechins
- Causality assessment methods to diagnose DILI
- Histology of DILI
- Treatment and prevention of DILI
- LiverTox
Links
Series:
- Gastroenterology and Hepatology
- Periodic Reports: Advances in Clinical Interventions and Research Platforms
Categories:
Therapeutic Areas:
Talk Citation
Lewis, J.H. (2021, January 31). Drug-induced liver injury: HDS, diagnosing, treating and preventing DILI [Video file]. In The Biomedical & Life Sciences Collection, Henry Stewart Talks. Retrieved February 5, 2025, from https://doi.org/10.69645/ZWUX8564.Export Citation (RIS)
Publication History
Financial Disclosures
- Prof. James H. Lewis has not informed HSTalks of any commercial/financial relationship that it is appropriate to disclose.
Drug-induced liver injury: HDS, diagnosing, treating and preventing DILI
Published on January 31, 2021
39 min
A selection of talks on Clinical Practice
Transcript
Please wait while the transcript is being prepared...
0:00
This is Dr. James H. Lewis.
I'm a professor of medicine and Director of Hepatology in the Division of
Gastroenterology at Georgetown University Medical Center, in Washington DC.
The topic for today's discussion is drug-induced liver injury,
where we've been and where we are headed.
0:20
The third part of the talk will include
the rising incidence of herbal and dietary supplement-related hepatotoxicity,
the current methods by which we attempt to diagnose DILI,
and the strategies used to treat and prevent DILI.
0:41
I want to turn to one of the most important areas of
drug-induced liver injury and that regards herbal and dietary supplement (HDS) hepatotoxicity.
This is on the rise in the United States and other Western countries.
Of course it's been seen for years in many of the Asian registries,
as I've already alluded to.
An important difference with the herbal and dietary supplements
causing hepatotoxicity is they often have a longer exposure before injury is recognized,
and causality is often confounded by incomplete knowledge of the list
of ingredients and the presence of adulterated or contaminated compounds.
1:24
This figure shows the rise in incidence in
herbal and dietary supplements causing DILI in
the US DILIN registry over the past decade.
The number of cases has in fact tripled over the past decade, and currently
represents nearly 20 percent of all cases of hepatic injury being reported.
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