Cholangitis: Diagnosis, Treatment and Prognosis

Area of Science:

• Hepatology
• Gastroenterology
• Immunology

Background:

• Cholangitis is a severe, life-threatening hepatobiliary disease.
• Understanding its diverse clinical and pathological features is crucial for effective management.
• Etiology and pathogenesis are heterogeneous across different cholangitis subtypes.

Purpose of the Study:

• To provide an updated review of the clinical and pathological features of various cholangitis forms.
• To synthesize current knowledge on the etiology, pathogenesis, diagnosis, and treatment of cholangitis.
• To highlight recent advancements in understanding IgG4-associated cholangitis (IAC).

Main Methods:

• Comprehensive literature search of PubMed, Scopus, and Web of Knowledge databases.
• Review of clinical presentations, pathological findings, and etiological factors.
• Analysis of diagnostic and therapeutic modalities, including imaging and medical treatments.

Main Results:

• Cholangitis encompasses primary sclerosing cholangitis (PSC), acute cholangitis (AC), and IgG4-associated cholangitis (IAC).
• PSC is chronic, progressive, associated with inflammatory bowel disease and neoplasia.
• AC is commonly caused by bacterial infections; IAC is linked to pancreatitis.
• Imaging (ERC, MRCP, EUS) and biliary drainage are vital for diagnosis and management.
• Antibiotics are effective for AC and PSC; immunosuppressants benefit IAC.

Conclusions:

• Cholangitis management requires a subtype-specific approach.
• Early diagnosis and intervention through advanced imaging and biliary drainage are critical.
• Targeted therapies, including antibiotics and immunosuppressants, show promise, with surgery reserved for refractory cases.