Cholestatic and metabolic liver diseases: Working Group report of the second World Congress of Pediatric Gastroenterology, Hepatology, and Nutrition.

Research1. To understand the mechanisms of drug-induced cholestasis.2. Which conditions are best treated by liver replacement therapy or bone marrow transplant, and how does one monitor the function of such cells?Intervention1. To develop common diagnostic pathways for cholestatic or metabolic liver disease.2. International network for rare diagnosis.3. What are the minimal skills needed to care for biliary atresia.Education1. Dissemination of practically useful research findings.2. International framework for re-education.Cholestatic and metabolic liver disease covers a wide range of conditions. At one end of the spectrum are rare genetic disorders and at the other are conditions such as biliary atresia. This report only addresses two research aspects directly. However, it suggests mechanisms for data collection and education. It is envisioned that these could easily be established worldwide and in turn would greatly aid all aspects of patient care and research.Although drug-induced cholestasis is relatively common, its many different forms mean that only a coordinated worldwide approach is likely to lead to rapid research progress. On the other hand, cell therapy techniques, such as hepatocyte transplantation, and bone marrow transplantation for metabolic liver disease are being performed in only a small number of centers. These centers do, however, represent great potential avenues. At the moment, we often lack the tools to know whether what we are doing works. This is therefore an important area for the future.The coordinated collection of research information, in a peer-reviewed fashion, is envisioned. This would feed many aspects of education and improve patient management. In a similar way, the minimum requirements involved in the planning of care for patients with biliary atresia is envisioned that would aid healthcare providers and purchasers and ultimately the patients.c 2004 Lippincott Williams a Wilkins, Inc.n