Assessment of drug-induced hepatotoxicity in clinical practice: A challenge for gastroenterologists

Table 5 Rationale for performing liver biopsy in a case suspected of having drug-induced hepatotoxicity

Clinical setting	Presentation
Any clinical context	Putative drugs not previously incriminated in liver toxicity
Acute or chronic liver disease	Female, autoantibody sero-positive
	High serum gammaglobulin and immunoglobulin G levels at presentation
	Incomplete or ambiguous de-challenge
Chronic alcoholism	Acute deterioration during aversive therapy (disulfiram, carbimide calcium)
Any acute liver deterioration in a patient with cirrhosis or chronic hepatitis C.	e.g. worsening of liver function in a patient with primary biliary cirrhosis receiving rifampicin or a chronic hepatitis C patient receiving ibuprofen
Chronic impairment in liver tests in non-jaundiced patients.	Especially if constitutional symptoms and/or clinical signs of portal hypertension are disclosed.
Young patients with sero-negative acute hepatitis or chronic liver disease.	Moderate decrease in ceruloplasmin levels or slight increases in urinary copper excretion.