Kumar R, Patel R, Priyadarshi RN, Narayan R, Maji T, Anand U, Soni JR. Amebic liver abscess: An update. World J Hepatol 2024; 16(3): 316-330 [PMID: 38577528 DOI: 10.4254/wjh.v16.i3.316]
Corresponding Author of This Article
Ramesh Kumar, MBBS, MD, Additional Professor, Department of Gastroenterology, All India Institute of Medical Sciences, Phulwari Sharif, Patna 801507, India. docrameshkr@gmail.com
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Review
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Mar 27, 2024; 16(3): 316-330 Published online Mar 27, 2024. doi: 10.4254/wjh.v16.i3.316
Amebic liver abscess: An update
Ramesh Kumar, Rishabh Patel, Rajeev Nayan Priyadarshi, Ruchika Narayan, Tanmoy Maji, Utpal Anand, Jinit R Soni
Ramesh Kumar, Rishabh Patel, Tanmoy Maji, Jinit R Soni, Department of Gastroenterology, All India Institute of Medical Sciences, Patna 801507, India
Rajeev Nayan Priyadarshi, Ruchika Narayan, Department of Radiodiagnosis, All India Institute of Medical Sciences, Patna 801507, India
Utpal Anand, Department of Surgical Gastroenterology, All India Institute of Medical Sciences, Patna 801507, India
Author contributions: Kumar R, Patel R, and Priyadarshi RN designed the study, collected data, analysed data, and wrote the manuscript; Narayan R, Maji T, Anand U and Soni JR contributed to data collection, critical inputs and manuscript writing and revision; all authors have read and approve the final manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Ramesh Kumar, MBBS, MD, Additional Professor, Department of Gastroenterology, All India Institute of Medical Sciences, Phulwari Sharif, Patna 801507, India. docrameshkr@gmail.com
Received: November 25, 2023 Peer-review started: November 25, 2023 First decision: January 15, 2024 Revised: January 23, 2024 Accepted: February 21, 2024 Article in press: February 21, 2024 Published online: March 27, 2024 Processing time: 123 Days and 6 Hours
Abstract
Amebic liver abscess (ALA) is still a common problem in the tropical world, where it affects over three-quarters of patients with liver abscess. It is caused by an anaerobic protozoan Entamoeba hystolytica, which primarily colonises the cecum. It is a non-suppurative infection of the liver consisting primarily of dead hepatocytes and cellular debris. People of the male gender, during their reproductive years, are most prone to ALA, and this appears to be due to a poorly mounted immune response linked to serum testosterone levels. ALA is more common in the right lobe of the liver, is strongly associated with alcohol consumption, and can heal without the need for drainage. While majority of ALA patients have an uncomplicated course, a number of complications have been described, including rupture into abdomino-thoracic structures, biliary fistula, vascular thrombosis, bilio-vascular compression, and secondary bacterial infection. Based on clinico-radiological findings, a classification system for ALA has emerged recently, which can assist clinicians in making treatment decisions. Recent research has revealed the role of venous thrombosis-related ischemia in the severity of ALA. Recent years have seen the development and refinement of newer molecular diagnostic techniques that can greatly aid in overcoming the diagnostic challenge in endemic area where serology-based tests have limited accuracy. Metronidazole has been the drug of choice for ALA patients for many years. However, concerns over the resistance and adverse effects necessitate the creation of new, safe, and potent antiamebic medications. Although the indication of the drainage of uncomplicated ALA has become more clear, high-quality randomised trials are still necessary for robust conclusions. Percutaneous drainage appears to be a viable option for patients with ruptured ALA and diffuse peritonitis, for whom surgery represents a significant risk of mortality. With regard to all of the aforementioned issues, this article intends to present an updated review of ALA.
Core Tip: Amebic liver abscess (ALA) is the most prevalent type of liver abscess in the tropical world. It has many peculiar characteristics, such as non-suppurative lesion, strong male predisposition, association with alcohol consumption, predilection for the right liver lobe, and potential for healing without drainage. Differentiating it from a pyogenic liver abscess can be challenging in clinical practice. The role of a serological test is limited in the endemic regions where microbiological evidence often requires molecular tests. Metronidazole continues to be the preferred agent for ALA. However, there are some growing concerns regarding the resistance against this drug. Drainage is often not required for the treatment of uncomplicated ALA. In the case of complicated ALA, a recent paradigm shift has led to the preference for percutaneous treatment over surgery, which carries a high mortality risk.
