Narrowing of the Bile Ducts Due to AIDS
Bile is a fluid that is produced by the liver and aids in digestion. Bile is transported through small tubes (bile ducts) that carry bile through the liver and then from the liver to the gallbladder and to the small intestine. (See also Overview of Gallbladder and Bile Duct Disorders.)
Before drugs to treat HIV infection (antiretroviral therapy) were widely used, AIDS cholangiopathy developed in about one fourth of people with AIDS.
The disorder causes pain in the upper right and upper middle parts of the abdomen. If the infection affects the small intestine, people also have diarrhea. A few people have fever and jaundice (a yellowish discoloration of the skin and whites of the eyes).
Diagnosis
ERCP may be done to confirm the diagnosis because it enables doctors to take a sample of infected tissue for examination under a microscope. Then doctors can identify the organism causing the infection. During ERCP, doctors can also widen (dilate) the narrowed bile ducts and thus relieve symptoms.
For ERCP, a flexible viewing tube (endoscope) with surgical attachments is passed through the mouth, down the esophagus, through the stomach, and into the small intestine (see Figure: Understanding Endoscopic Retrograde Cholangiopancreatography). A thin catheter is passed through the endoscope, through the ring-shaped muscle between the common bile and pancreatic ducts and small intestine (sphincter of Oddi), and up into the common bile duct. A radiopaque contrast agent, which is visible on x-rays, is then injected through the catheter into the bile ducts, and x-rays are taken to detect any abnormalities.
Alternatively, ultrasonography may be done to help confirm the diagnosis. It is less invasive and is very accurate.
Blood tests to determine how well the liver is functioning and whether it is damaged (liver tests) are usually also done. The results can support the diagnosis.
Treatment
During endoscopic retrograde cholangiopancreatography (ERCP), a surgical instrument is passed through the endoscope and used to cut the sphincter of Oddi—a procedure called endoscopic sphincterotomy. Cutting the sphincter of Oddi allows bile to pass into the small intestine. This procedure helps relieve pain, jaundice, and inflammation. If only one part of a duct is narrowed, a tube may be passed through the endoscope and placed in the affected spot to widen it.
Antimicrobial drugs are given to treat the infection.
