The edition · Gastroenterology & Hepatology
The AASLD–AGA guideline sets a PBC pathway, and supplements now drive a growing share of drug-induced liver injury
Six recommendations cover AMA-negative diagnosis, UDCA first line, stiffness for prognosis, PPAR agonists after inadequate response and linerixibat for itch. Twenty years of US registry data show herbal and dietary supplements rising as a cause of liver injury.
The edition in brief
A joint AASLD–AGA guideline on primary biliary cholangitis makes six recommendations: PBC-specific antinuclear antibodies when antimitochondrial antibody is negative, ursodeoxycholic acid as first-line therapy, liver stiffness for prognosis, PPAR agonists for inadequate response or intolerance to UDCA, linerixibat for moderate-to-severe pruritus, and UDCA after transplantation to reduce recurrence; certainty ranged from moderate to very low. A global multisociety consensus sets a unified definition and grading framework for acute-on-chronic liver failure. The US DILIN registry of 1,983 high-causality drug-induced liver injury cases (2004–2024) found antibiotics still the commonest cause but falling, while herbal and dietary supplements and anticancer drugs rose; oncology patients had 30% six-month mortality. A Hepatology review summarises MRI fat fraction and MR elastography thresholds in MASLD, including a 43% higher decompensation risk per 1-kPa rise in stiffness. The pearl covers judging UDCA response at one year.
A global multisociety consensus unifies the definition of acute-on-chronic liver failure
A unified global definition of ACLF now exists; align local assessment and grading with it so international evidence can be applied.
Supplements and cancer drugs are a growing share of drug-induced liver injury
In suspected drug-induced liver injury, ask directly about supplements and herbal products; their share is rising.
MRI thresholds for fat and stiffness in MASLD, and what a rising stiffness means
Use MRI fat fraction and MR elastography thresholds to interpret imaging in MASLD; a rising stiffness signals higher decompensation risk.
Judge UDCA response in PBC at one year
Check alkaline phosphatase and bilirubin after a year of weight-based UDCA; persistent abnormality means second-line treatment.
AASLD–AGA guideline: UDCA first, PPAR agonists second, and linerixibat for itch in PBC
In PBC, start UDCA, assess response and stiffness, and escalate to a PPAR agonist for inadequate response where available.
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