Electrocardiographic Changes in Cholecystitis and Cholangitis

Electrocardiographic (ECG) changes associated with biliary diseases, including cholecystitis and cholangitis, have been sporadically reported; however, detailed observational data remain scarce. This study aimed to investigate the prevalence and characteristics of ECG abnormalities in patients with cholecystitis and cholangitis, and to identify associated clinical factors.

We conducted a retrospective analysis of 402 patients hospitalized for biliary diseases between January 2018 and January 2025. After excluding patients without comparable ECGs or with confounding cardiovascular conditions, 79 cholecystitis and 111 cholangitis cases were included. ECG changes such as T-wave abnormalities, ST-segment deviations, and conduction blocks were evaluated. Clinical variables, including demographics, laboratory results, disease severity (Tokyo Guidelines), and comorbidities, were compared between patients with and without ECG changes.

ECG abnormalities were observed in 43% of cholecystitis cases and 34% of cholangitis cases. In both groups, T-wave abnormalities-particularly negative T-waves-were the most common findings, followed by ST-segment changes and conduction blocks. In cholecystitis, ECG changes were significantly associated with lower serum potassium levels and higher disease severity. In cholangitis, a history of stroke and elevated alkaline phosphatase (ALP) levels were significantly associated with ECG changes. All ECG abnormalities normalized following appropriate treatment of the underlying biliary disease.

Electrocardiographic changes were observed in a significant proportion of patients with either cholecystitis or cholangitis. Awareness of the potential association between biliary disease and electrocardiographic abnormalities is essential to avoid misdiagnosis and to ensure appropriate management in acute care settings.