From the Guidelines
Cholangitis is an infectious disease characterized by acute inflammation and infection in the bile ducts, typically caused by a combination of biliary obstruction and bacterial growth in bile, and requires prompt medical attention with intravenous antibiotics and biliary decompression to prevent progression to sepsis. The most common cause of cholangitis is choledocholithiasis, which is the presence of gallstones in the bile ducts 1. Symptoms of cholangitis include fever, abdominal pain, jaundice, dark urine, and sometimes confusion. Treatment of cholangitis involves adequate antimicrobial treatment and biliary decompression to restore biliary drainage in case of obstruction 1. The key elements of therapy in acute cholangitis are:
- Adequate antimicrobial treatment to avoid or manage the septic complications
- Biliary decompression to restore biliary drainage in case of obstruction Some of the key procedures used to treat cholangitis include:
- Endoscopic retrograde cholangiopancreatography (ERCP) to remove gallstones or place stents to improve bile drainage
- Percutaneous transhepatic cholangiography (PTC) to drain the bile ducts
- Open surgical drainage in severe cases where other methods are not feasible According to the most recent guidelines, ERCP plays a central role in the management of biliary obstruction in patients with acute cholangitis, and is the treatment of choice for biliary decompression in patients with moderate/severe acute cholangitis 1. In addition, antibiotics such as piperacillin-tazobactam, ceftriaxone plus metronidazole, or ciprofloxacin plus metronidazole should be used for 4-7 days to treat the infection 1. It's also important to note that recurrent cholangitis may play a role in the progression of the disease, and high-grade strictures with stagnation of bile may facilitate bacterial colonization 1. Overall, prompt and effective treatment of cholangitis is crucial to prevent morbidity, mortality, and to improve quality of life.
From the Research
Definition and Overview of Cholangitis
- Cholangitis is an infectious disease of the biliary system that can cause significant morbidity and mortality 2.
- It is often characterized by fever, abdominal pain, and jaundice (Charcot's triad) as well as confusion and septic shock (Reynolds' pentad) 3.
- Cholangitis can be acute or chronic, with acute cholangitis being a medical emergency that requires prompt treatment.
Causes and Risk Factors
- Common bile duct stones (choledocholithiasis) are a major cause of acute cholangitis 4, 2, 3.
- Other risk factors include biliary tract surgery, endoscopic retrograde cholangiopancreatography (ERCP), and biliary stents 5, 3.
- Bacterial infection is a key component of cholangitis, with gram-negative bacteria such as Escherichia coli and Klebsiella pneumoniae being common pathogens 4.
Diagnosis and Treatment
- Diagnosis of cholangitis is based on clinical presentation, laboratory tests, and imaging studies such as ultrasound and CT scans 3.
- Treatment of cholangitis involves antimicrobial therapy and biliary drainage, with endoscopic retrograde cholangiopancreatography (ERCP) being a common method of biliary drainage 2, 3.
- Prompt and effective treatment is critical to prevent complications and improve outcomes, as cholangitis can be life-threatening if left untreated or inadequately treated 2, 3, 6.
Types of Cholangitis
- Acute cholangitis is a severe and potentially life-threatening condition that requires immediate medical attention 2, 3.
- Cholangitis lenta is a rare and uncommon type of cholangitis characterized by ductular reaction with inspissated bile in dilated ductules, often associated with sepsis and high mortality rates 6.