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An Approach to Drug-Induced Liver Injury from the Geriatric Perspective

  • Gastroenterology in Geriatric Patients (S Chokhavatia, Section Editor)
  • Published:
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Abstract

Purpose of Review

With its high variability in both presentation and severity, drug-induced liver injury (DILI) is a complex condition increasingly confronting all providers. DILI has an even more muddled presentation among the geriatric population due to age-related changes in liver physiology and biochemistry as well as polypharmacy common in the geriatric population.

Recent Findings

Most cases of DILI are idiosyncratic and unpredictable. DILI, especially related to herbal and dietary supplement (HDS) use, is increasingly recognized as a leading cause of acute liver failure and need for liver transplantation. Unfortunately, liver transplantation is a limited option for the elderly, a population that exhibits significant HDS use. One recent study suggests that early use of N-acetylcysteine may be useful in preventing progression to acute liver failure in non-acetaminophen DILI. In the future, a personalized medicine approach using genomic signatures may be feasible to prevent DILI.

Summary

This review serves to raise recognition of the unique aspects of DILI in the geriatric population to promote rapid diagnosis and early intervention to prevent progression to liver failure and death. For now, DILI remains a diagnosis of exclusion, and care providers for the elderly must focus on obtaining a thorough history that includes HDS use and intervening early in suspected DILI cases.

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Authors and Affiliations

  1. Division of Liver Diseases, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA

    Brian T. Lee, Joseph A. Odin & Priya Grewal

  2. Recanati/Miller Transplantation Institute, The Mount Sinai Hospital, New York, NY, USA

    Joseph A. Odin & Priya Grewal

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  1. Brian T. Lee
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Contributions

Lee: initial draft of the manuscript, approved the final draft to be submitted. Odin: revised draft of the manuscript, approved the final draft to be submitted. Grewal: revised draft of the manuscript, approved the final draft to be submitted.

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Correspondence to Joseph A. Odin.

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All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

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The authors declare no competing interests.

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This article is part of the Topical Collection on Gastroenterology in Geriatrics Patients

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Lee, B.T., Odin, J.A. & Grewal, P. An Approach to Drug-Induced Liver Injury from the Geriatric Perspective. Curr Gastroenterol Rep 23, 6 (2021). https://doi.org/10.1007/s11894-021-00804-7

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