{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T16:32:32Z","timestamp":1791822752724,"version":"4.3.4"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","license":[{"start":{"date-parts":[[2017,2,7]],"date-time":"2017-02-07T00:00:00Z","timestamp":1486425600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1"},{"start":{"date-parts":[[2017,2,7]],"date-time":"2017-02-07T00:00:00Z","timestamp":1486425600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatology"],"published-print":{"date-parts":[[2017,4]]},"abstract":"<jats:p>Bile duct loss during the course of drug\u2010induced liver injury is uncommon, but can be an indication of vanishing bile duct syndrome (VBDS). In this work, we assess the frequency, causes, clinical features, and outcomes of cases of drug\u2010induced liver injury with histologically proven bile duct loss. All cases of drug\u2010induced liver injury enrolled into a prospective database over a 10\u2010year period that had undergone liver biopsies (n\u2009=\u2009363) were scored for the presence of bile duct loss and assessed for clinical and laboratory features, causes, and outcomes. Twenty\u2010six of the 363 patients (7%) with drug\u2010, herbal\u2010, or dietary\u2010supplement\u2013associated liver injury had bile duct loss on liver biopsy, which was moderate to severe (&lt;50% of portal areas with bile ducts) in 14 and mild (50%\u201075%) in 12. The presenting clinical features of the 26 cases varied, but the most common clinical pattern was a severe cholestatic hepatitis. The implicated agents included amoxicillin\/clavulanate (n\u2009=\u20093), temozolomide (n\u2009=\u20093), various herbal products (n\u2009=\u20093), azithromycin (n\u2009=\u20092), and 15 other medications or dietary supplements. Compared to those without, those with bile duct loss were more likely to develop chronic liver injury (94% vs. 47%), which was usually cholestatic and sometimes severe. Five patients died and 2 others underwent liver transplantation for progressive cholestasis despite treatment with corticosteroids and ursodiol. The most predictive factor of poor outcome was the degree of bile duct loss on liver biopsy. <jats:italic toggle=\"yes\">Conclusion<\/jats:italic>: Bile duct loss during acute cholestatic hepatitis is an ominous early indicator of possible VBDS, for which at present there are no known means of prevention or therapy. (H<jats:sc>epatology<\/jats:sc> 2017;65:1267\u20101277)<\/jats:p>","DOI":"10.1002\/hep.28967","type":"journal-article","created":{"date-parts":[[2016,12,17]],"date-time":"2016-12-17T14:09:47Z","timestamp":1481983787000},"page":"1267-1277","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":135,"title":["Clinical presentations and outcomes of bile duct loss caused by drugs and herbal and dietary supplements"],"prefix":"10.1097","volume":"65","author":[{"given":"Herbert L.","family":"Bonkovsky","sequence":"first","affiliation":[{"name":"Wake Forest Baptist Medical Center,Winston\u2010Salem,NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David E.","family":"Kleiner","sequence":"additional","affiliation":[{"name":"National Cancer Institute (NCI),National Institutes of Health (NIH),Bethesda,MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jiezhun","family":"Gu","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute,Durham,NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph A.","family":"Odin","sequence":"additional","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai,New York,NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mark W.","family":"Russo","sequence":"additional","affiliation":[{"name":"Carolinas HealthCare System,Charlotte,NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor M.","family":"Navarro","sequence":"additional","affiliation":[{"name":"Einstein Medical Center,Philadelphia,PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert J.","family":"Fontana","sequence":"additional","affiliation":[{"name":"University of Michigan School of Medicine,Ann Arbor,MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marwan S.","family":"Ghabril","sequence":"additional","affiliation":[{"name":"Indiana University\u2010Purdue University,Indianapolis,IN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huiman","family":"Barnhart","sequence":"additional","affiliation":[{"name":"Duke Clinical Research Institute,Durham,NC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay H.","family":"Hoofnagle","sequence":"additional","affiliation":[{"name":"National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), NIH,Bethesda,MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"for the U.S. Drug Induced Liver Injury Network 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