[131] Currently, the agar dilution method, microdilution method, and Epsilometer (E) test are used as antibiotic susceptibility tests for H. pylori. Although the Clinical and Laboratory Standards Institute recommends

the agar dilution method as the primary test of antibiotics resistance, it can be used only for research purposes.[132] Recently, a simple new method has been developed for clarithromycin-resistant H. pylori using polymerase chain reaction, which can be easily implemented by primary clinics but needs further clinical data.[133] We would like to express our sincere gratitude to Eun-Ae Jeong, PhD of the Library of Medicine of Soonchunhyang University who searched Selleckchem HM781-36B existing guidelines during the first phase of the systematic literature review. In addition, we would like to thank Prof. Young Woon Chang (Department of Internal Medicine, Kyung Hee University College of Medicine), and Prof. Nayoung Kim (Department of Internal

Medicine, Seoul National University College of Medicine) who reviewed the draft of this manuscript in the peer review process. Appendix S1 Formulate research question. “
“We read with great interest the article by Björnsson et al.1 on the topic of 22 LY294002 cases of drug-induced autoimmune hepatitis (DIAIH). Although DIAIH is considered relatively rare, Lucena et al.2 recently reported four cases diagnosed with AIH on the second episode of drug-induced liver injury (DILI). With the findings in their studies, Björssen et al. concluded that a significant proportion of patients with AIH have DIAIH,

whereas Lucena et al. concluded that second episodes of DILI are more likely to be associated with features of AIH. We have also recently encountered seven cases with intriguing clinical courses, which were diagnosed as DILI but features of AIH became apparent later despite discontinuation of drugs, suggesting a different pattern of the etiology. Patient characteristics are shown in Table 1. In each case, liver dysfunction had not been documented before pharmacotherapy, and treatment was promptly suspended without changing to any Metalloexopeptidase other drugs when elevated levels of serum aminotransferase were detected. Liver dysfunction improved after discontinuation of causal drugs, but relapsed later in all cases despite continued cessation of drugs. Interestingly, antinuclear antibody (ANA) titer and immunoglobulin (Ig)G levels were significantly increased at relapse compared to first onset. Histological examinations were performed at relapse in three cases, revealing portal inflammation and interface hepatitis. AIH was diagnosed in all cases because every one of them met the criteria for at least “probable AIH” according to the international scoring system.3 Steroid therapy improved liver dysfunction and no cases of relapse have been seen. One of the most important and interesting features of these cases is that ANA titers or serum IgG levels increased during the course.