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.