The Efficacy of Albumin Dialysis in the Treatment of Severe Cholestatic Drug-Induced Liver Injury.

Drug-induced liver injury (DILI) is a significant cause of acute liver injury and can present as cholestatic injury with or without associated hepatitis. Although most patients with DILI recover with supportive care, some can develop severe refractory cholestasis that impairs recovery of hepatic function, with subsequent progression to acute or chronic liver failure. Current pharmacotherapy and extracorporeal therapies such as hemodialysis have limited benefit. Albumin dialysis is an emerging strategy in the extracorporeal treatment of intoxications caused by protein bound drugs and can be used for the removal of albumin bound bilirubin and bile acids. CASES SERIES: We describe the efficacy of albumin dialysis with the molecular adsorbent recirculating system (MARS) in the successful treatment of five patients with severe cholestatic DILI that was refractory to standard medical therapy. All patients had a sustained improvement in serum bilirubin levels after completing MARS therapy, with a complete resolution of their liver injury. DISCUSSION: Our case series demonstrates that albumin dialysis could provide an important treatment strategy in the setting of severe refractory cholestatic DILI and be considered as a novel therapeutic option in specific cases of drug hepatotoxicity in which the causative agent has high protein binding characteristics.

HSV-1 Ulcers as an Infrequent Cause of Hematochezia.

We report a 62-year-old woman in the intensive care unit who developed hematochezia. Her endoscopic findings revealed diffusely bleeding esophageal ulcers related to herpes simplex virus. The bleeding was treated successfully with Hemospray.

Peptic Ulcer Disease and Helicobacter pylori infection.

Peptic ulcer disease (PUD) is a common condition that both primary care providers and gastroenterologists encounter. Symptoms of peptic ulcer disease are variable and may include abdominal pain, nausea, vomiting, weight loss and bleeding or perforation with complicated disease. Identifying the risk factors and mechanisms that lead to the development of PUD helps to understand the approach behind diagnostic and treatment strategies.

Endoscopic Appearance and Management of Recto-Sigmoid Endometriosis: Case Report.

Endometriosis is the presence of endometrial glands outside the uterine cavity. Endometriosis can involve any part of the bowel but most commonly affects the recto-sigmoid part of the bowel. This case shows the endoscopic views of bowel endometriosis and also elaborates on how to approach and manage similar cases of bowel endometriosis. Patients with bowel endometriosis are better managed and treated with a multidisciplinary team including gastroenterologist, gynecologist and colorectal surgeon.