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Expert consensus on the clinical management of pyrrolizidine alkaloid‐induced hepatic sinusoidal obstruction syndrome

Zhuge, Yuzheng, Liu, Yulan, Xie, Weifen, Zou, Xiaoping, Xu, Jianming, Wang, Jiyao, Chinese Society of Gastroenterology Committee of Hepatobiliary Disease·2019·Journal of Gastroenterology and Hepatology
DOI 10.1111/jgh.14612
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Abstract

Hepatic sinusoidal obstruction syndrome (HSOS) is a hepatic vascular disease presenting with abdominal distension, pain in the hepatic region, ascites, jaundice, and hepatomegaly. In China, this disease is often associated with the oral intake of plants that contain pyrrolidine alkaloids. The existing guidelines are limited to HSOS associated with hematopoietic stem cell transplantation in Western countries. The Hepatobiliary Diseases Committee of the Chinese Society of Gastroenterology convened an expert consensus conference on the diagnosis and treatment of PA–HSOS to evaluate current research in China and abroad. The “Nanjing criteria” developed by the committee to diagnose PA–HSOS include a confirmed history of PA‐containing plant use and (i) abdominal distention and/or pain in the hepatic region, hepatomegaly, and ascites; (ii) elevation of serum total bilirubin or abnormal laboratory liver tests; (iii) evidence on enhanced computed tomography or magnetic resonance imaging; or (iv) pathological evidence that rules out other known causes of liver injury. Supportive symptomatic treatment, anticoagulant therapy, and placement of a transjugular intrahepatic portosystemic shunt for patients who do not respond to medical treatment are effective for the treatment of PA–HSOS. The benefits of glucocorticoids and prostaglandin E1 in PA–HSOS are not clear.

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  • Stepwise therapy with anticoagulants (low-molecular-weight heparin and/or warfarin) and transjugular intrahepatic portosystemic shunt (TIPS) is currently the recommended standard therapy for PA-HSOS, confirmed in multiple retrospective studies.

    “Stepwise therapy with anticoagulants (low-molecular-weight heparin and/or warfarin) and transjugular intrahepatic portosystemic shunt (TIPS) is currently the recommended standard therapy, which has been confirmed in multiple retrospective studies [89].”

    From Chinese guideline for the diagnosis and treatment of drug-induced liver injury: an update (2024) · cites this paper as [89]

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Metadata

Authors
Zhuge, Y., Liu, Y., Xie, W., Zou, X., Xu, J., Wang, J., & Chinese Society of Gastroenterology Committee of Hepatobiliary Disease
Venue
Journal of Gastroenterology and Hepatology
Publisher
Wiley
Published
2019-02-21
Volume
34
Issue
4
Pages
634-642
ISSN
  • 0815-9319
  • 1440-1746
DOI
10.1111/jgh.14612
Cited by
107
References
0
Language
en
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Funders
Digestive Disease and Medical Center of Gastrointestinal Tumor of Jiangsu Province (YXZXB2016002)

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