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Recent trends in the diagnosis and management of biliary atresia in developing countries

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Abstract

Need and purpose of review

Biliary atresia is a progressive obstructive cholangiopathy and is fatal if left untreated within 2 years of life. Delay in referral is because of difficulties in differentiating it from physiologic jaundice and identifying an abnormal stool color. This paper presents an overview on the diagnosis and discusses the current strategies in the management of this disease in developing countries.

Methods

Articles were retrieved from the PubMed database using the terms ‘biliary atresia’, ‘Kasai portoenterostomy’ and ‘pediatric liver transplantation’. Contents of the article are also based on personal experience of the authors.

Conclusion

A national screening program using stool color cards as part of standard care in the neonatal period will greatly improve early detection of biliary atresia. Outcomes will improve if it is diagnosed at the earliest after birth, the child is referred to an experienced pediatric hepatobiliary unit for evaluation, and undergoes an early Kasai procedure. If an early Kasai portoenterostomy is performed, nearly half of all children survive into adolescence, and about one-third are likely to have a long-term, symptom-free life with normal liver biochemistry. Sequential treatment combining Kasai as first line and liver transplantation as second line results in 90% survival for children with biliary atresia.

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Authors and Affiliations

  1. Institute of Liver Disease and Transplantation, Global Health City, #439, Cheran Nagar, Perumbakkam, Chennai, 600 100, India

    Priya Ramachandran, Mohamed Safwan, Mettu Srinivas Reddy & Mohamed Rela

  2. Childs Trust Medical Research Foundation, National Foundation for Liver Research, Chennai, India

    Priya Ramachandran, Mohamed Safwan, Mettu Srinivas Reddy & Mohamed Rela

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  1. Priya Ramachandran
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  2. Mohamed Safwan
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  4. Mohamed Rela
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Correspondence to Mohamed Rela.

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Ramachandran, P., Safwan, M., Reddy, M.S. et al. Recent trends in the diagnosis and management of biliary atresia in developing countries. Indian Pediatr 52, 871–879 (2015). https://doi.org/10.1007/s13312-015-0735-6

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