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[8,15] In our study also, the majority of infants had bile amylase [http://www.selleckchem.com/products/INCB18424.html Ruxolitinib cell line] higher biliary amylase levels compared to the spherical group. Four of 5 patients who had long common channel had biliary amylase >500 IU/L (P = 0.05). Three of them had fusiform dilatation. This association of fusiform dilatation with AUPBJ may be the cause of the higher incidence of presentation with abdominal pain in our study. Pancreatitis and dysplasia in GB and CC are also therefore likely to be higher but were not corroborated in our study. Ono et al. noted epithelial hyperplasia, chronic cholecystitis, and intramural fibrosis in GB irrespective of the type of dilatation.[17] A significantly higher incidence of mucosal hyperplasia in the fusiform than in the spherical type has been reported.[8,18] Although not statistically significant, in our study, amylase levels were higher in GB compared to CC in the fusiform group. Iwai et al. also detected significantly higher biliary amylase levels in GB (91,284 �� 24,238 U/L) compared to CC (42,160 �� 9,091 U/L) in fusiform dilatation.[19] In our study, both CC and GB showed inflammatory changes with no dysplasia in either groups perhaps due to the age of presentation. However, we feel that these differences may predispose to dysplasia/metaplasia in GB epithelium especially [http://en.wikipedia.org/wiki/Megestrol_acetate Megestrol Acetate] in the fusiform group if treatment is delayed. Obstructive cholangiopathy can lead to liver fibrosis in 35-66.7% patients although progression to cirrhosis is known to occur only in 2.1-11.8%.[20] Gong et al. noted a higher fibrosis score in the infantile group (2.5 �� 0.9) compared to pediatric group (1.5 �� 1.2) (P [http://www.selleckchem.com/products/SB-431542.html TGF-beta inhibitor] had features of fibrosis or cirrhosis on HPE compared to 25% with fusiform dilatation. Overall, cirrhosis was seen in 57% infants and 6.7% older children (P