Duodenal Diverticula: A Review of 28 Cases (original) (raw)

2008, European Journal of Internal Medicine

We retrospectively reviewed all clinical records of patients with DILI admitted to our Unit from February 1996 to December 2006. A database was constructed, reporting data regarding age, sex, clinical features at onset, laboratory results, suspected drugs and follow-up. The diagnosis of DILI was based on the presence of at least three of the International Consensus Criteria (J Hepatol 1990). Liver damage was defined as hepatocellular, cholestatic or mixed, according to clinical and laboratory data, since histology was performed only in a minority of patients. All patients were negative for hepatitis A, B, C, EBV and CMV serology and non organ-specific autoantibody screening. Results: Forty six cases out of 6,134 patients received a discharge diagnose of DILI. There were 23 men and 23 women, mean age was 54.2 (range 11-88 yrs), 35 patient (74%) were older than 40 years. Five patients had an associated chronic liver disease (2 cirrhosis and 3 HCV-related chronic hepatitis). At clinical presentation all patients had abnormal liver function tests (LFTs), 22 patients were jaundiced and 3 patients was admitted for hepatic failure, manifest as hepatic encephalopathy. Liver damage was hepatocellular in 19 patients, cholestatic in 15 and mixed in 12. In 10 (22%) of cases, two or more drugs were involved. NSAIDs (n =17), psychotropic drugs (n =7) and antibiotics (n =10) were the most commonly involved drugs, followed by anti-platelet, anti-diabetic drugs and statins. NSAIDs were involved in three cases of acute liver failure and, among them, one was listed for liver transplantation but died while on the waiting list. All patients had regular follow-up visits every three months for at least one year after discharge. All patients, including those with pre-existing liver disease had a complete normalization of LFTs at the end of follow-up. Conclusions: Severe DILI requiring hospital admission is very rare and appears more common in patients over 40 years. NSAIDs, psychotropic drugs and antibiotics are the most common responsible drugs. Even in severe cases, recovery is almost the rule and only a few patients have an unfavourable course and eventually die