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Adjuvant treatments for biliary atresia
Jessica Burns1, Mark Davenport1
1Department of Paediatric Surgery, King's College Hospital, London, UK.
Translational Pediatrics
|August 11, 2020
Summary
Adjuvant medical therapies for biliary atresia (BA) show limited proven benefits. High-dose steroids and ursodeoxycholic acid (UDCA) may offer some advantages, while other treatments require further investigation.
Area of Science:
- Pediatric Gastroenterology
- Hepatology
- Surgical Innovation
Background:
- Biliary atresia (BA) is a rare liver disease requiring surgical intervention, primarily Kasai portoenterostomy (KPE).
- Liver transplantation is a secondary option for unresectable cases.
- The exact cause of BA is unknown, leading to empirical adjuvant treatments.
Purpose of the Study:
- To review the current evidence on the efficacy of adjuvant medical therapies in biliary atresia.
- To evaluate the effectiveness of various medical treatments used alongside surgical interventions for BA.
Main Methods:
- Systematic analysis of randomized placebo-controlled trials and cohort studies.
- Review of evidence for post-operative steroids, ursodeoxycholic acid (UDCA), antibiotics, bile acid sequestrants, probiotics, antiviral therapy (AVT), immunoglobulin, FXR agonists, and IBAT antagonists.
Main Results:
- Post-operative high-dose steroids and UDCA show some suggested benefits.
- The efficacy of long-term prophylactic antibiotics, bile acid sequestrants, and probiotics remains unproven.
- Emerging therapies like AVT, immunoglobulin, FXR agonists, and IBAT antagonists are currently unproven in BA.
Conclusions:
- Evidence for most adjuvant medical therapies in biliary atresia is limited or unproven.
- Further research is needed to establish the role and efficacy of these treatments in improving outcomes for BA patients.
