Hepatobiliary infections

The major hepatobiliary infections (excluding the viral hepatitides) includ e amebic and pyogenic liver abscess and cholangitis, Little new information has been published in the area of cholangitis during the last several year s, In contrast, the clinical presentation and management of liver abscess h ave evolved considerably, not only in the last several years but also durin g a more extended period spanning the last two decades. In the United State s, amebic liver abscess occurs largely in individuals from endemic areas or in those traveling to endemic areas, Recent data suggest that patients wit h human immunodeficiency virus (HIV) infection are at an increased incidenc e of amebic liver abscess. New serologic tests and molecular techniques are being added to the diagnostic armamentarium for amebic liver abscess, In m ost cases, amebic liver abscess is associated with an excellent prognosis ( up to 100% survival) if properly managed, Pyogenic liver abscess, although commonly occurring in patients with known biliary tract disease, is often c ryptogenic in origin (ie, no clear causal factor can be identified) or ofte n is caused by underlying medical disorders, An emerging population of pati ents with pyogenic liver abscess includes those with complications of aggre ssive interventions (hepatic chemoembolization, cryoablation, liver transpl antation). Pyogenic liver abscess was predominantly managed by surgical met hods up until the early 1980s, but almost entirely has changed to being man aged by interventional techniques; in 2000, this trend has continued, In co ntrast to amebic liver abscess, pyogenic liver abscess is associated with g reater morbidity and mortality, ostensibly caused by the severity of the un derlying disease in many patients. However, it should be emphasized that th e prognosis of patients with pyogenic liver abscess, who do not have underl ying comorbid conditions, is excellent. Curr Opin Gastroenterol 2001, 17:25 7-261 (C) 2001 Lippincott Williams & Wilkins, Inc.