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Papillary Stenosis and Sclerosing Cholangitis in the Acquired Immunodeficiency Syndrome

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Grant support: in part by training grant AM 07007 from the National Institutes of Health.

▸Requests for reprints should be addressed to John P. Cello, M.D.; Division of Gastroenterology, San Francisco General Hospital, 1001 Potrero Avenue, Room 3C-19; San Francisco, CA 94110.

San Francisco, California

© 1987 American College of PhysiciansAmerican College of Physicians

Ann Intern Med. 1987;106(4):546-549. doi:10.7326/0003-4819-106-4-546
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Eight homosexual men with the acquired immunodeficiency syndrome (AIDS) presented with clinical, biochemical, and radiologic features of stenosis of the papilla of Vater and sclerosing cholangitis. This newly recognized complication of AIDS produces abdominal pain, nausea, and vomiting and may predispose patients to superimposed bacterial cholangitis. Marked elevation of serum alkaline phosphatase levels and lesser changes in hepatic aminotransferase levels are common. Although abdominal ultrasonography and computed tomography detect ductal abnormalities, endoscopic retrograde cholangiography best shows precise ductal irregularities and provides therapeutic intervention. Prompt relief of symptoms follows endoscopic sphincterotomy, often with resolution of biochemical evidence of cholestasis. Biliary tract infection with cytomegalovirus or Cryptosporidia and resultant viral or coccidial cholangitis are the proposed pathophysiologic mechanisms.





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