How is AIDS cholangiopathy best diagnosed?
- The most common laboratory finding in this syndrome is a markedly elevated alkaline phosphatase, usually more than three times the upper limits of normal.
- Typically bilirubin is not elevated and rarely exceeds 3 mg/dL, and transaminases are only mildly elevated.
- Generally, these patients have a dilated bile duct that is identifiable on abdominal ultrasonography.
- The diagnosis of AIDS cholangiopathy is best established by endoscopic retrograde cholangiopancreatography.
- The diagnosis is usually established by obtaining biopsy specimens of the ampulla or duodenal mucosa, bile duct biopsy, aspirated bile specimens, or biliary epithelial brush cytologic examination.
- Several cholangiographic patterns have been described, including papillary stenosis, sclerosing cholangitis, combined papillary stenosis and sclerosing cholangitis, isolated intrahepatic disease, and long extrahepatic bile duct strictures.
- The most common pattern is papillary stenosis with intrahepatic sclerosing cholangitis. Endoscopic sphincterotomy is appropriate for the relief of pain in patients with papillary stenosis and dilated ducts.
