Adjuvant treatments for biliary atresia
The treatment of biliary atresia (BA) is predominantly surgical with firstly an attempt at restoration of bile flow form the native liver by wide excision of the obstructed, obliterated extrahepatic biliary tree to the level of the porta hepatis and a portoenterostomy using a long Roux loop. Liver transplantation is reserved for those that fail this and for those where surgery is considered futile for reasons of age or stage of disease. As the aetiology of BA remains undecided, so adjuvant treatment has been largely based on pragmatism, trial and error. Systematic analysis of the few randomized placebo-controlled trial data and less well-controlled cohort studies have suggested benefit from post-operative high-dose steroids and ursodeoxycholic acid (UDCA) while the benefit of long-term prophylactic antibiotics remains unproven. This article reviews the evidence for the efficacy of adjuvant medical therapy in BA.