Vanishing bile duct syndrome in drug-induced liver injury: clinical and pathologic perspectives

Vanishing bile duct syndrome (VBDS) is a rare condition, representing approximately 0.5% of small bile duct diseases, characterized by progressive destruction of intrahepatic bile ducts, leading to ductopenia. This condition encompasses various etiologies, with drug-induced VBDS (D-VBDS) accounting for 7% of VBDS cases. D-VBDS arises from liver injury due to chemical drugs, traditional medicines, and dietary supplements, often resulting in inflammatory responses and necrosis of bile duct epithelium. Recent years have seen a rise in reported cases, making drug-related injuries a leading cause of acute liver failure in Western countries. This review provides a comprehensive analysis of VBDS, focusing on the histopathological features of acute and chronic D-VBDS, alongside exploring its clinical presentation, prognostic implications, and future research directions. Understanding the diverse etiologies, clinical manifestations, and biochemical parameters associated with D-VBDS is essential for improving diagnosis, treatment strategies, and patient outcomes.