Differentiation of Biliary Atresia from the Intrahepatic Etiology of Infantile Cholestasis with Alagille Criteria

Biliary atresia (BA) is an important etiology of liver disease in pediatric patients which manifests as extrahepatic cholestasis. Alagille criterion is a combination of noninvasive findings for the diagnosis of BA. In this regard, the current retrospective study aimed to evaluate the diagnostic accuracy of Alagille criteria for BA.
This cross-sectional study was conducted in Ghaem Hospital, affiliated to Mashhad University of Medical Sciences during 2009-2014. All infants less than 2 years old with cholestasis referred to the pediatric gastrointestinal ward were included in this study. Alagille criteria were evaluated for each patient, and BA was confirmed with intraoperative cholangiography. Finally, sensitivity, specificity, and positive and negative predictive values of Alagille criteria were determined according to the final diagnosis.
In general, 92 patients were included in this study. The male-to-female ratio and the mean age of patients were 54/38 and 42±5 days (ranging between 1 and 5 months), respectively. There was a significant difference between the two groups in terms of gender, onset time of jaundice, and the presence of the acholic stool (P=0.02, 0.04, and 0.005, respectively). Eventually, the acholic stool had the highest sensitivity, specificity, and positive and negative predictive values.
Based on the findings, the presence of the acholic stool was the most valuable criterion for the diagnosis of BA among all Alagille criteria.