The study of the epidemiology of toxic liver injury has been limited in Korea. The number of hospitalizations for toxic liver injury has been estimated to be 2,400 persons per year. About 30~40% of fulminant hepatitis was attributed to toxic hepatitis. The frequent causative agents of toxic hepatitis in Korea are herbal medicines (34~40%), folk remedies (23~34%), and prescribed medicines (24~55%). However, the most common agents causing severe liver injury including fulminant hepatitis are herbal medicine and folk remedies. Antituberculosis drugs and acetaminophen are two common causes of fulminant hepatitis among prescribed drugs. Alcohol is one of the leading causes of chronic liver disease in Korea. No nationwide study on the epidemiology of alcoholic liver disease (ALD) has been carried out, but 7~31% of cirrhosis has been reported to be alcoholic in a few single-center studies. Alcohol could be a risk factor for the development of hepatocellular carcinoma (HCC) in chronic viral hepatitis. Several studies have shown that alcohol increased the risk of HCC in liver cirrhosis with HBsAg or anti-HCV. Furthermore, alcoholic cirrhosis with occult hepatitis B virus infection increased the risk of HCC.
Drug-Induced Liver Injury/diagnosis/*epidemiology/etiology ; Humans ; Korea/epidemiology ; Liver Cirrhosis, Alcoholic/complications/epidemiology ; Liver Diseases, Alcoholic/complications/*epidemiology ; Liver Neoplasms/etiology ; Risk Factors

OBJECTIVETo study the clinical features of drug-induced liver injury in children.

METHODSThe clinical data of the hospitalized children with drug-induced liver injury over 5 years were retrospectively reviewed.

RESULTSOf 641 cases of hospitalized children with liver injury, there were 64 cases (10%) of drug induced liver injury. Hepatocellular injury was the most common type of drug-induced liver injury (81%). The major drugs causing drug-induced liver injury included chemotherapy drugs, antibiotics and anti-tuberculosis drugs. Rash (16%), gastrointestinal reaction (15%), fever (14%) and liver intumescence (12%) were common clinical symptoms. A part of patients with drug-induced liver injury (11%) had no symptoms and signs.

CONCLUSIONSDrug-induced liver injury is one of the common causes of liver damage in hospitalized children. Some children with drug-induced liver injury have no symptoms and signs. Hepatocellular injury is a major type of drug-induced liver injury in children, resulting less severe liver damage.

Adolescent ; Chemical and Drug Induced Liver Injury ; diagnosis ; epidemiology ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Male ; Retrospective Studies

Liver injury due to prescription and nonprescription medications is a growing medical, scientific, and public health problem. Worldwide, the estimated annual incidence rate of drug-induced liver injury (DILI) is 13.9-24.0 per 100,000 inhabitants. DILI is one of the leading causes of acute liver failure in the US. In Korea, the annual extrapolated incidence of cases hospitalized at university hospital is 12/100,000 persons/year. Most cases of DILI are the result of idiosyncratic metabolic responses or unexpected reactions to medication. There is marked geographic variation in relevant agents; antibiotics, anticonvulsants, and psychotropic drugs are the most common offending agents in the West, whereas in Asia, 'herbs' and 'health foods or dietary supplements' are more common. Different medical circumstances also cause discrepancy in definition and classification of DILI between West and Asia. In the concern of causality assessment, the application of the Roussel Uclaf Causality Assessment Method (RUCAM) scale frequently undercounts the cases caused by 'herbs' due to a lack of previous information and incompatible time criteria. Therefore, a more objective and reproducible tool that could be used for the diagnosis of DILI caused by 'herbs' is needed in Asia. In addition, a reporting system similar to the Drug-Induced Liver Injury Network (DILIN) in the US should be established as soon as possible in Asia.
Dietary Supplements/adverse effects ; Drug-Induced Liver Injury/*diagnosis/epidemiology/*pathology ; Herbal Medicine ; Humans ; Liver Failure, Acute/pathology ; Prognosis ; Risk Factors ; Severity of Illness Index

Anti-Bacterial Agents ; adverse effects ; Anti-Infective Agents ; adverse effects ; Anti-Inflammatory Agents ; adverse effects ; Biomarkers ; blood ; Chemical and Drug Induced Liver Injury ; diagnosis ; epidemiology ; Child ; Drug-Related Side Effects and Adverse Reactions ; Humans ; Liver ; drug effects ; metabolism ; pathology ; Pediatrics ; Risk Factors

Drug-induced liver injury (DILI) remains a significant clinical challenge and is the leading cause of acute liver failure in most countries. An aging population that uses more medications, a constant influx of newly developed drugs and a growing risk from unfamiliar herbal and dietary supplements will make DILI an increasing part of clinical practice. Currently, the most effective strategy for disease management is rapid identification, withholding the inciting agents, supportive care and having a firm understanding of the expected natural history. There are resources available to aid the clinician, including a new online "textbook" as well as causality assessment tools, but a heightened awareness of risk and the disease's varying phenotypes and good history-taking remain cornerstones to diagnosis. Looking ahead, growing registries of cases, pharmacoepidemiology studies and translational research into the mechanisms of injury may produce better diagnostic tools, markers for risk and disease, and prevention and therapeutics.
Age Factors ; Anti-Infective Agents/adverse effects ; Anti-Inflammatory Agents, Non-Steroidal/adverse effects ; Anticonvulsants/adverse effects ; Biopsy ; Dietary Supplements/adverse effects ; Drug-Induced Liver Injury/*diagnosis/epidemiology ; Drugs, Chinese Herbal/adverse effects ; Humans ; Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects ; Incidence ; Liver/pathology ; Liver Function Tests ; Risk Factors ; Tumor Necrosis Factor-alpha/antagonists & inhibitors