Help
Subscribe


GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy

 27 August 2016

Advanced search
GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy Profile of Roy Pounder

Home

News  
Journals
Review Articles
Slide Atlas
Video Clips
Online Books
Advanced Digestive Endoscopy
Classical Cases
Conference Diary
PubMed
International GH Links
USA GH Links
National GH Links
National GI Societies
Other Useful Links




Emails on Gastroenterology and Hepatology
the National AIDS Treatment Advocacy Project
Visit the gastroenterology section of the EUMS

News

Steroid treatment associated with earlier onset of adverse events in children with biliary atresia

This week's publication of the Journal of the American Medical Association investigates the use of corticosteroids after hepatoportoenterostomy for bile drainage in infants with biliary atresia.

News image

Biliary atresia is the most common cause of end-stage liver disease in children.

Controversy exists as to whether use of steroids after hepatoportoenterostomy improves clinical outcome.

Dr Jorge Bezerra and colleagues determined whether the addition of high-dose corticosteroids after hepatoportoenterostomy is superior to surgery alone in improving biliary drainage and survival with the native liver.

The research team performed a multicenter, double-blind Steroids in Biliary Atresia Randomized Trial (START) in 140 infants between 2005 and 2011 in the United States.

The team's follow-up ended in January 2013.

Transplant-free survival was about 59% in the steroids group
Journal of the American Medical Association

Participants were randomized to receive intravenous methylprednisolone, and oral prednisolone followed by a tapering protocol for 9 weeks or placebo initiated within 72 hours of hepatoportoenterostomy.

The team's primary end point was the percentage of participants with a serum total bilirubin level of less than 1.5 mg/dL with his/her native liver at 6 months posthepatoportoenterostomy.

Secondary outcomes included survival with native liver at 24 months of age and serious adverse events.

The researchers found that proportion of participants with improved bile drainage was not statistically significantly improved by steroids at 6 months posthepatoportoenterostomy of placebo group.

The team observed that the adjusted absolute risk difference was 9%.

Transplant-free survival was about 59% in the steroids group, and in the placebo group at 24 months of age.

The team noted that the percentage of participants with serious adverse events was 81% of the steroids group, and 80% of the placebo group.

However, participants receiving steroids had an earlier time of onset of their first serious adverse event by 30 days posthepatoportoenterostomy.

Dr Bezerra's team concludes, "Among infants with biliary atresia who have undergone hepatoportoenterostomy, high-dose steroid therapy following surgery did not result in statistically significant treatment differences in bile drainage at 6 months, although a small clinical benefit could not be excluded."

"Steroid treatment was associated with earlier onset of serious adverse events in children with biliary atresia."

JAMA 2014;311(17):1750-1759
08 May 2014

Go to top of page Email this page Email this page to a colleague

 26 August 2016 
Bleeding after endoscopic dissection-induced gastric ulcers
 26 August 2016 
Reasons for premature surveillance colonoscopy
 26 August 2016 
Celiac disease therapeutics
 25 August 2016 
Post-infectious IBS in C. diff
 25 August 2016 
Stool DNA test for colorectal cancer screening
 25 August 2016 
Short-chain fatty acids in mixed refractory constipation
 24 August 2016 
Genetics and therapy response in IBD
 24 August 2016 
Hep B after infant vaccination program
 24 August 2016 
Obeticholic acid for primary biliary cholangitis
 23 August 2016 
Colorectal cancer genetics as biomarkers
 23 August 2016 
Prognostic test for mortality after liver transplant
 23 August 2016 
Postoperative mortality in elderly with IBD
 22 August 2016 
Celiac disease in the elderly
 22 August 2016 
Laparoscopic vs open colectomy databases
 22 August 2016 
Mucosal healing and ulcerative colitis outcomes
 19 August 2016 
Dietary questionnaire for GI clinics
 19 August 2016 
Botox treatment for chronic anal fissure
 19 August 2016 
Myeloid-derived suppressor cells in GI cancers
 18 August 2016 
Gallstone formation determinants
 18 August 2016 
Age disparities in IBD therapy
 18 August 2016 
Seasonal variation in diverticulitis
 17 August 2016 
IBD activity score for routine clinical use
 17 August 2016 
Attitudes to H. pylori in primary care
 17 August 2016 
Nonselective β-blockers and mortality in cirrhosis
 16 August 2016 
Upper GI lesions in adults with IBD
 16 August 2016 
C. difficile infection and mortality when managed by GI surgeons
 16 August 2016 
HCV eradication in cirrhosis
 15 August 2016 
Predicting favorable outcomes in IBD
 15 August 2016 
Scoring system predicted microscopic colitis
 15 August 2016 
Mortality in spontaneous bacterial peritonitis
 12 August 2016 
Recurrence of resected gastric cancer
 12 August 2016 
Screening for pancreatic cancer
 12 August 2016 
Index for diagnostic accuracy of Crohn's
 11 August 2016 
Colorectal neoplasm on surveillance colonoscopies
 11 August 2016 
Bowel disease in primary care patients with bowel symptoms
 11 August 2016 
Diagnosis in covert hepatic encephalopathy
 10 August 2016 
Maintenance therapy for children with eosinophilic esophagitis
 10 August 2016 
Moderate alcohol use and insulin action in HCV
 10 August 2016 
Consensus on the management of GERD
 09 August 2016 
Pancreatitis quality of life instrument
 09 August 2016 
Gallstone disease and NAFLD
 09 August 2016 
Steroid dependency and IBD
 08 August 2016 
Venous thromboembolism in celiac disease
 08 August 2016 
C. diff in IBD 
 08 August 2016 
Gut-directed hypnotherapy vs low FODMAP diet in IBS
 05 August 2016 
Therapy for H.pylori treatment
 05 August 2016 
Obesity and the development of NAFLD
 05 August 2016 
Obesity and CVD in celiac disease
 04 August 2016 
Bleeding after endoscopic resection of colorectal lesions
 04 August 2016 
Novel risk factor for post-ERCP pancreatitis
 04 August 2016 
Ondansetron for children with acute gastroenteritis
 03 August 2016 
Post-colonoscopy complications
 03 August 2016 
IVF in women with IBD
 03 August 2016 
Post-operative pancreatic fistulae after pancreatic surgery
 02 August 2016 
H. pylori in children
 02 August 2016 
Gastric cancer in patients with gastric intestinal metaplasia
 02 August 2016 
Behavioral changes and bariatric surgery
 01 August 2016 
Relapse after cessation of oral antiviral treatment in Hep B
 01 August 2016 
Antimicrobial resistance of H. pylori
 01 August 2016 
Colorectal cancers in IBD

Blackwell Publishing


GastroHep.com is a Blackwell Publishing registered trademark
© 2016 Wiley-Blackwell and GastroHep.com and contributors
Privacy Statement
Disclaimer
About Us