PANCREATIC ABNORMALITIES AND AIDS-RELATED SCLEROSING CHOLANGITIS

Objectives: Biliary tract abnormalities are well recognised in AIDS, m ost frequently related to opportunistic infection with Cryptosporidium , Microsporidium, and cytomegalovirus. We noted a high frequency of pa ncreatic abnormalities associated with biliary tract disease. To defin e these further we reviewed the clinical and radiological features in these patients. Methods: Notes and radiographs were available from two centres for 83 HIV positive patients who had undergone endoscopic ret rograde cholangiopancreatography for the investigation of cholestatic liver function tests or abdominal pain. Results: 56 patients had AIDS related sclerosing cholangitis (ARSC); 86% of these patients had epiga stric or right upper quadrant pain and 52% had hepatomegaly. Of the pa tients with ARSC, 10 had papillary stenosis alone, 11 had intra-and ex trahepatic sclerosing cholangitis alone, and 35 had a combination of t he two. Ampullary biopsies performed in 24 patients confirmed an oppor tunistic infection in 16. In 15 patients, intraluminal polyps were not ed on the cholangiogram. Pancreatograms were available in 34 of the 45 patients with papillary stenosis, in which 29 (81%) had associated pa ncreatic duct dilatation, often with associated features of chronic pa ncreatitis. In the remaining 27 patients, final diagnoses included dru g induced liver disease, acalculous cholecystitis, gall bladder empyem a, chronic B virus hepatitis, and alcoholic liver disease.Conclusion: Pancreatic abnormalities are commonly seen with ARSC and may be respon sible for some of the pain not relieved by biliary sphincterotomy. The most frequent radiographic biliary abnormality is papillary stenosis combined with ductal sclerosis.