Although drug-induced liver injury (DILI) is a rare clinical event, it carries significant morbidity and mortality, leaving it as the leading cause of acute liver failure in the United States. It is one of the most challenging diagnoses encountered by gastroenterologists. The development of various drug injury networks has played a vital role in expanding our knowledge regarding drug-related and herbal and dietary supplement-related liver injury. In this review, we discuss what defines liver injury, epidemiology of DILI, its biochemical and pathologic patterns, and management. (Hepatology Communications 2020;4:631-645). and Kidney Diseases established the U.S. DILI Network (DILIN) in 2003 to identify, enroll, and characterize cases of non-APAP DILI and herbal and dietary supplements (HDSs). (13) The U.S. DILIN has two registry studies at eight different academic centers across the United States. The network has expanded our understanding of DILI. Antimicrobials were noted to be the most common causative agents, accounting for 45% of cases in a 2004 study, followed by HDSs, cardiovascular drugs, central nervous system agents, antineoplastic agents, and analgesics. (14) Of the antimicrobials, amoxicillin-clavulanate (22%), isoniazid (11.7%), and nitrofurantoin (10.2%) were the top three implicated agents. (14) The network has also noted an increasing proportion of HDS-related liver injury,

Benign anastomotic strictures can occur in up to 22% of patients who undergo colonic or rectal resection. Traditionally, surgery was the preferred method of treatment, but, over time, endoscopic techniques, such as balloon dilation, have become the preferred modality. However, a high stricture recurrence rate of up to 18-20% and the increased risk of perforation due to uncontrolled stretching are its major drawbacks. Endoscopic electrocautery incision (EECI) allows for controlled mucosal incision in predetermined locations of stricture. In this meta-analysis, we have summarized case reports, case series, retrospective studies and prospective studies describing the different endoscopic EECI techniques used for benign lower gastrointestinal tract anastomotic strictures. Our analysis showed that EECI, either alone or in combination with other modalities (e.g. balloon dilation, steroid injection or argon plasma coagulation) is an effective treatment option for both treatment-naïve and refractory short non-inflammatory strictures. The overall success rate for EECI-based therapy for benign colorectal stricture was 98.4%, with a stricture recurrence rate of 6.0%. No major adverse event (bleeding, infection or perforation) was reported. Only minor adverse events (abdominal pain) were reported in 3.8% of the population.

This study has identified an association between body mass index and Clostridium difficile infection severity. A BMI>35 kg/m is an independent risk factor for severe community-onset and hospital-onset Clostridium difficile infections.

Plummer-Vinson syndrome is a rare condition associated with dysphagia, iron deficiency, and esophageal webs. Data regarding this condition is limited to mostly case reports and a few small cohort studies. Although most cases have a benign and indolent course, the risk of malignancy warrants long-term surveillance. A multidisciplinary approach among healthcare providers is of the utmost importance in the management of this condition.

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