title: 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.affiliation: Section of Gastroenterology and Hepatology, Iceland.
authors.forename: Hafsteinn O
authors.initials: HO
authors.lastname: Gudnason
authors.affiliation: Section of Gastroenterology and Hepatology, Iceland; Faculty of Medicine, University of Iceland, Iceland.
authors.forename: Helgi K
authors.initials: HK
authors.lastname: Björnsson
authors.affiliation: Department of Radiology, Faculty of Medicine, University of Iceland, Iceland.
authors.forename: Marianna
authors.initials: M
authors.lastname: Gardarsdottir
authors.affiliation: Department of Radiology, Faculty of Medicine, University of Iceland, Iceland.
authors.forename: Hjalti M
authors.initials: HM
authors.lastname: Thorisson
authors.affiliation: Section of Gastroenterology and Hepatology, Iceland.
authors.forename: Sigurdur
authors.initials: S
authors.lastname: Olafsson
authors.affiliation: Section of Gastroenterology and Hepatology, Iceland.
authors.forename: Ottar M
authors.initials: OM
authors.lastname: Bergmann
authors.affiliation: Section of Gastroenterology and Hepatology, Iceland; Faculty of Medicine, University of Iceland, Iceland; National University Hospital of Iceland, Iceland. Electronic address: einarsb@landspitali.is.
authors.forename: Einar S
authors.initials: ES
authors.lastname: Björnsson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D056486:Chemical and Drug Induced Liver Injury / Q000150:complications*; D049448:Cholangiopancreatography, Magnetic Resonance; D015209:Cholangitis, Sclerosing / Q000175:diagnosis / Q000209:etiology*; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
keywords: Bile duct injury; Bile duct strictures; Biliary tract abnormalities; Cholestatic injury