Biliary Atresia: advances and challenges in early diagnosis and management.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
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de Carvalho Elisa, Ciocca Mirta Elba, Porta Gilda, Sandy Natascha Silva, Timossi Carlos Marcelo, Godoy Marcela, López Carola, Higuera Michelle, Miura Irene, Silveira Themis Reverbel, Álvarez Fernando, Vázquez-Frías Rodrigo, Morise Silvia Filomena, Boldrini Hector Gustavo, Ramonet Margarita Dolores, Cuarterolo Miriam Liliana, Costaguta Alejandro, Carusi Rosana Pérez, Ferreira Cristina Helena Targa, Bellomo-Brandão Maria Angela, Neri Sandra, de Marsillac Marise Elia, Sawamura Regina, Navarro Dianora, Marques Cibele Dantas Ferreira, Goñi Juan Juanet, González Lorena Rodríguez, Soriano Humberto E, Llanillo Loreto Hierro, Bezerra Jorge Abdon
Аннотация
SOURCES: Relevant literature was identified through structured searches of PubMed and other major biomedical databases, complemented by manual review of reference lists from key original studies, systematic reviews, and position papers addressing biliary atresia and neonatal cholestasis.
SUMMARY OF THE FINDINGS: Biliary atresia remains a highly time-critical disease in pediatric hepatology, with outcomes strongly determined by age at surgical intervention. Population-based screening strategies, particularly stool color card programs, have shown meaningful reductions in age at surgery in selected regions, although their effectiveness is highly dependent on healthcare system organization and follow-up capacity. However, acholic stools remain a valuable sign for clinicians. Laboratory biomarkers such as gamma-glutamyl transferase and matrix metalloproteinase-7 provide complementary diagnostic support. Imaging modalities and liver biopsy continue to play essential roles in the diagnostic work-up. However, several commonly used tests predominantly reflect advanced disease and may be less informative in the earliest stages. Evidence supporting postoperative adjuvant therapies remains heterogeneous, with ongoing controversies regarding their impact on long-term native liver survival.
CONCLUSIONS: Despite important advances, early diagnosis of biliary atresia remains challenging in many settings. Integrating clinical vigilance with the judicious use of screening strategies, biomarkers, and diagnostic procedures is essential to optimize outcomes. Continued efforts are needed to refine early diagnostic pathways and to address persistent gaps in evidence, standardization, and access to specialized care.