Journal of Clinical and Translational Hepatology

Journal of Clinical and Translational Hepatology

Friday, 09 / 21 / 2018

Articles

Cholangitis: Diagnosis, Treatment and Prognosis

REVIEW ARTICLE

Cholangitis: Diagnosis, Treatment and Prognosis

Amir Houshang Mohammad Alizadeh

Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Correspondence to: Amir Houshang Mohammad Alizadeh, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Parvaneh Ave, Tabnak Str, Evin, Tehran 19857, Iran. Tel: +98-21-22432521, Fax: +98-21-22432517, E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Journal of Clinical and Translational Hepatology 2017;5(4):404-413 DOI: 10.14218/JCTH.2017.00028

Received: April 28, 2017 Accepted: July 12, 2017 Published online: September 7, 2017

Abstract

Cholangitis is a serious life-threatening situation affecting the hepatobiliary system. This review provides an update regarding the clinical and pathological features of various forms of cholangitis. A comprehensive search was performed in the PubMed, Scopus, and Web of Knowledge databases. It was found that the etiology and pathogenesis of cholangitis are heterogeneous. Cholangitis can be categorized as primary sclerosing (PSC), secondary (acute) cholangitis, and a recently characterized form, known as IgG4-associated cholangitis (IAC). Roles of genetic and acquired factors have been noted in development of various forms of cholangitis. PSC commonly follows a chronic and progressive course that may terminate in hepatobiliary neoplasms. In particular, PSC commonly has been associated with inflammatory bowel disease. Bacterial infections are known as the most common cause for AC. On the other hand, IAC has been commonly encountered along with pancreatitis. Imaging evaluation of the hepatobiliary system has emerged as a crucial tool in the management of cholangitis. Endoscopic retrograde cholangiography, magnetic resonance cholangiopancreatography and endoscopic ultrasonography comprise three of the modalities that are frequently exploited as both diagnostic and therapeutic tools. Biliary drainage procedures using these methods is necessary for controlling the progression of cholangitis. Promising results have been reported for the role of antibiotic treatment in management of AC and PSC; however, immunosuppressive drugs have also rendered clinical responses in IAC. With respect to the high rate of complications, surgical interventions in patients with cholangitis are generally restricted to those patients in whom other therapeutic approaches have failed.

Keywords

Primary sclerosing cholangitis, Acute cholangitis, IgG4-associated cholangitis, Endoscopic retrograde cholangiography, Magnetic resonance cholangiopancreatography, Endoscopic ultrasonography

 

Journal of Clinical and Translational Hepatology 2017 vol. 5, 404-413 Html ] [ PDF Full-text ]

© The Authors 2017. This article is published under the terms of the Creative Commons Attribution-Noncommercial License (CC BY-NC 4.0), which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license.

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