Deciphering the liver enigma: distinguishing drug-induced liver injury and metabolic dysfunction-associated steatotic liver disease—a comprehensive narrative review

Author:

García-Cortés Miren1ORCID,Toro-Ortiz Juan Pedro2ORCID,García-García Alberto2ORCID

Affiliation:

1. Service of Gastroenterology and Hepatology, University Virgen de la Victoria Hospital, 29010 Málaga, Spain; Instituto de investigación Biomédica de Málaga (IBIMA)-Plataforma Bionand, University of Málaga, 29010 Málaga, Spain; Centro de Investigación Biomédico en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain

2. Service of Gastroenterology and Hepatology, University Virgen de la Victoria Hospital, 29010 Málaga, Spain

Abstract

Drug-induced liver injury (DILI) poses a complex and heterogeneous clinical challenge, which often resembles non-drug related acute or chronic liver diseases, such as metabolic dysfunction-associated steatotic liver disease (MASLD). Furthermore, certain drugs can induce hepatic steatosis, which is considered a rare variant of hepatotoxicity. Additionally, the detection and diagnosis of DILI in patients with non-alcoholic liver disease present additional challenges that require attention. The importance of achieving an accurate diagnosis is highlighted by the different therapeutic approaches needed for each of these diseases. Nonetheless, as definitive diagnostic tests and distinct biomarkers often remain elusive, the differential diagnosis must rely on a combination of clinical, biochemical, histological, and immunophenotypic profiling. The diagnosis of hepatotoxicity is predicated upon the temporal nexus between the administration of a potentially hepatotoxic drug and the onset of hepatic injury, concomitantly excluding alternative hepatic pathologies. More frequently, this condition presents an acute course, with a more pronounced elevation of cytolytic and cholestatic parameters as compared to fatty liver disease. Advances in elucidating the underlying mechanisms hold promise for bolstering the diagnosis and management of these conditions. This article aims to thoroughly examine and emphasize the currently available scientific evidence to provide valuable insights into the diagnostic strategies for DILI, metabolic-associated liver disease, and drug-induced steatosis (DIS).

Publisher

Open Exploration Publishing

Subject

General Medicine,General Earth and Planetary Sciences,General Environmental Science,General Medicine,Ocean Engineering,General Medicine,General Medicine,General Medicine,General Medicine,General Earth and Planetary Sciences,General Environmental Science,General Medicine

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