What is the treatment for biliary atresia in infants?

Biliary atresia is a disease that affects the bile ducts in infants and requires surgical treatment, as it cannot be corrected with medication alone. The primary goal of treatment is to restore bile flow from the liver to the intestines to prevent its accumulation, which can lead to liver damage and fibrosis over time [5]. Thanks to advancements in treatment, more than 80 to 90 percent of infants with biliary atresia survive into adulthood [4].

The Kasai Procedure: Initial Surgical Intervention

The "Kasai procedure" is considered the initial surgical treatment for most infants with biliary atresia. During this procedure, the surgeon removes the damaged or blocked bile ducts outside the liver. Next, a portion of the infant's small intestine is used to create an alternative path that connects the liver directly to the intestine, allowing bile to drain [4]. The Kasai procedure does not completely cure biliary atresia, but it may slow down liver damage and delay or prevent complications and the need for a liver transplant. The earlier the surgery is performed, the more effective it is [4]. The success of the surgery typically becomes apparent within 3 months, as skin yellowing (jaundice) decreases in most successful cases and the risk of developing advanced liver disease complications is reduced.

Liver Transplant: Advanced Surgical Solution

Despite the success of the Kasai procedure, most children will gradually develop complications of biliary atresia over years or decades and will eventually require a liver transplant. If biliary atresia leads to serious complications, the infant or child will need a liver transplant [4]. A liver transplant involves replacing the diseased or damaged liver with a healthy one from a donor. In some rare cases, children may not require a liver transplant following a successful Kasai procedure [4].

Follow-up and Long-term Care

This condition requires continuous medical follow-up to monitor liver function. After the Kasai procedure, cholangitis is a common complication. Doctors may prescribe antibiotics after surgery to help prevent this inflammation. If cholangitis occurs, it is treated with antibiotics, usually intravenously in the hospital [4]. Parents must adhere to periodic follow-up plans to ensure the best possible outcomes, as health challenges vary from one child to another. Additional information regarding bile duct diseases in general can be found in Bile Duct Diseases: From Gallstones to Inflammation and Treatment Methods (Arabic).

How Does Nutrition Support Child Development After Treatment?

Bile flow deficiency may persist after the Kasai procedure, affecting fat digestion and the absorption of certain vitamins, and increasing the risk of malnutrition and poor growth. A doctor or dietitian will develop a plan tailored to the child, which may include special infant formula or supplements added to milk or food, such as fat-soluble vitamins or fats that are easier to digest. If oral feeding is insufficient, the team may recommend a feeding tube or other methods depending on the case. The dosages of these supplements are not determined by general information; the individual plan must be followed, and the child's growth and nutrition must be monitored with the medical team [6].

Medical references

• Treatment for Biliary Atresia - NIDDK
• Definition & Facts of Biliary Atresia - NIDDK
• Eating, Diet, & Nutrition for Biliary Atresia - NIDDK