A pilot study of the value of a stool color card as a diagnostic tool for extrahepatic biliary atresia at a single tertiary referral center in a low/middle income country

El‐Shabrawi, Mortada; Baroudy, Sherif; Hassanin, Fetouh; Farag, Ahmed E.

doi:10.1016/j.ajg.2020.12.004

Cited by 6 publications

(4 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“… 27 Patients who reported stool color indicative of BA were more likely to have Kasai performed within 60 days. El-Shabrawi et al, 28 implemented SCC in tertiary centers in Egypt and the card proved to be highly sensitive (93.48%; 95% CI: 82.1–98.63) and specific (90.32%; 95% CI 80.12–96.37) for early diagnosis of BA, even where parental education level was low. Perhaps employing and promoting measures such as stool cards and measurement of serum conjugated bilirubin as part of newborn screening at our center may expedite earlier diagnosis of BA in children and facilitate better outcomes.…”

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Outcome of Infants with Biliary Atresia in Bahrain

Isa¹,

Irshad²

2023

Oman Med J

View full text Add to dashboard Cite

Objectives: Though the prevalence of biliary atresia (BA) in the Middle East is low, its role in causing life-threatening liver diseases is disproportionately high. This study aimed to assess the prevalence, clinical presentations, diagnosis, surgical interventions, and long-term outcomes including survival rate, and to analyze prognostic factors affecting the survival of infants with BA in Bahrain. Methods: A retrospective cohort review of cases of infants diagnosed with BA between January 1993 and December 2021 at Salmaniya Medical Complex, Bahrain, was conducted. Demographic, clinical, laboratory, imaging, and histopathological data were analyzed. Outcomes measured included 5-year native liver survival (NLS) and overall liver survival (OLS) rates. Results: Out of 27 infants diagnosed with BA, 26 were included in the study. The overall prevalence was 0.007% and was significantly higher among Bahraini (0.006%) compared to the non-Bahraini population (0.001%), p< 0.001. Most patients had clay-colored stool (19 of 22; 86.4%) and hepatomegaly (18; 81.8%). Kasai procedure was performed in 23 (88.5%) patients and primary liver transplant (LT) in three. Ten (38.5%) infants required LT after the Kasai procedure. The median age at diagnosis was 56 days with interquartile range (IQR) of 30–90, and the median age at the Kasai procedure was 61 days (IQR = 56–90). NLS and OLS rates were 53.8% and 65.4%, respectively. The overall mortality rate was 34.6%. Six of the 13 (46.2%) patients who were subjected to Kasai procedure alone died awaiting LT donors. Infants with lower birth weight and older age at diagnosis had significantly better odds of survival (p< 0.029 and p< 0.044, respectively). Conclusions: BA is uncommon among infants in Bahrain. Despite effective treatment options, late diagnosis can lead to significant morbidity and mortality. Our study found a relatively low prevalence of NLS (53.8%) and OLS (65.4%). Since the majority of the diagnosed patients had presented with clay-colored stools, implementing an infant stool card for screening may be beneficial in raising parental awareness and detecting BA early. Early detection and treatment using novel therapies are likely to improve the survival rates.

show abstract

Section: Discussionmentioning

confidence: 99%

Clinical Characteristics and Outcome of Infants with Biliary Atresia in Bahrain

Isa¹,

Irshad²

2023

Oman Med J

View full text Add to dashboard Cite

show abstract

“…National BA screening programs using an SCC have been introduced in Switzerland and Japan [36,49]. Small pilot studies with the SCC have been conducted in regions or municipalities in Brazil [50], Cairo, Egypt [51], Shenzen (China) [52], Northern Portugal [53], and Lower Saxony Germany [54]. However, to our knowledge, comprehensive feasibility and performance studies of the SCC in these locales have not yet been reported.…”

Section: Ba Screening Using a Stool Color Cardmentioning

confidence: 99%

“…Considerations must be given to families' first language and socioeconomic status to ensure the instructions are clearly understood. Recent input from developing countries support the concept that this screening process is simple and easily understood even in lower socioeconomic groups and those with illiteracy [51].…”

Section: Ba Screening and Public Health Policy: The Challenge Of Infl...mentioning

confidence: 99%

Biliary Atresia in 2021: Epidemiology, Screening and Public Policy

Schreiber

Harpavat

Hulscher

et al. 2022

JCM

View full text Add to dashboard Cite

Biliary atresia (BA) is a rare newborn liver disease with significant morbidity and mortality, especially if not recognized and treated early in life. It is the most common cause of liver-related death in children and the leading indication for liver transplantation in the pediatric population. Timely intervention with a Kasai portoenterostomy (KPE) can significantly improve prognosis. Delayed disease recognition, late patient referral, and untimely surgery remains a worldwide problem. This article will focus on biliary atresia from a global public health perspective, including disease epidemiology, current national screening programs, and their impact on outcome, as well as new and novel BA screening initiatives. Policy challenges for the implementation of BA screening programs will also be discussed, highlighting examples from the North American, European, and Asian experience.

show abstract

“…Bilirubin >1 mg/d direct/conjugated serum bilirubinmeans cholestasis and the study protocol must be initiated [2]. Stool assessment is most helpful [12,13].Evaluation at one month of age using the stool color chart helps confirming acholic stools, which characterizes obstructive biliary conditions like BA [14]. If cholestasis is confirmed, the patient must be referred for assessment by a specialist.…”

Section: Diagnostic Approach In Newborns and Infantsmentioning

confidence: 99%

Cholestasis in Newborns and Infants

Cáceres¹

2022

Int J Pediatr Neonatal Prim Care

View full text Add to dashboard Cite

Cholestatic jaundice early in life is infrequent but always abnormal and must be investigated because early diagnosis is crucial to identify treatable diseases, improving the outcome and quality of life of patients. Some diagnostic tools are efficient but expensive and frequently they are not available everywhere, making difficult to reach universally applicable algorithms. In fact, criteria available in the literature often depend on the facilities of the centres where studies are performed. This explains why until today clinical assessment and frequent clinical check-ups early in life remain being main diagnostic tools for a timely diagnosis and management. This is a narrative review updates the state of the art on neonatal cholestasis and based on the evidence gathered a diagnostic approach is proposed., which considers alternatives depending on the local capacities, emphasizing the need of early recognition of altered stools and conjugated bilirubin, and opportune referral to specialized centres.

show abstract

A pilot study of the value of a stool color card as a diagnostic tool for extrahepatic biliary atresia at a single tertiary referral center in a low/middle income country

Cited by 6 publications

References 17 publications

Clinical Characteristics and Outcome of Infants with Biliary Atresia in Bahrain

Clinical Characteristics and Outcome of Infants with Biliary Atresia in Bahrain

Biliary Atresia in 2021: Epidemiology, Screening and Public Policy

Cholestasis in Newborns and Infants

Contact Info

Product

Resources

About