Acute Cholangitis Management and Diagnostic Strategies

Acute cholangitis is a potentially life-threatening infection of the biliary tract, most often precipitated by biliary obstruction from gallstones, strictures or malignancy. The current diagnostic approach combines clinical assessment—fever, right-upper-quadrant pain and jaundice—with laboratory markers of inflammation and cholestasis and imaging, typically ultrasound or cross-sectional modalities. Severity assessment utilises scoring systems that integrate physiological parameters, laboratory values and organ dysfunction to stratify patients for urgent intervention. Initial management focuses on haemodynamic resuscitation, broad-spectrum antibiotic therapy and prompt biliary decompression. Endoscopic retrograde cholangiopancreatography (ERCP) is the mainstay for drainage in most centres, with percutaneous or surgical approaches reserved for failed or inaccessible endoscopic access. Emerging strategies include tailored antibiotic regimens based on local resistance patterns and minimising treatment duration once source control is achieved. Novel biomarkers derived from the microbiome and refined risk-prediction models offer potential for earlier detection of severe disease and individualised management pathways.

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Acute Cholangitis Management and Diagnostic Strategies publication trend

The graph below shows the total number of articles in acute cholangitis management and diagnostic strategies across all publications each year (not limited to Nature Index journals).

Technical terms

Acute cholangitis: Infection of the biliary tract characterised by obstruction, inflammation and systemic symptoms.

Endoscopic retrograde cholangiopancreatography (ERCP): An endoscopic technique combining fluoroscopy and endoscopy to diagnose and treat biliary and pancreatic ductal disorders, primarily used for biliary decompression in cholangitis.

Biomarker: A measurable biological molecule found in blood, tissue or other fluids that can indicate normal or pathogenic processes or pharmacological responses to a therapeutic intervention.

Multi-drug resistant (MDR) pathogens: Microorganisms that have developed resistance to multiple classes of antimicrobial agents, complicating empiric therapy in biliary infections.

References

1. Elevated plasma and bile levels of corisin, a microbiota-derived proapoptotic peptide, in patients with severe acute cholangitis. Gut Pathogens (2023).
2. Timing of Performing Endoscopic Retrograde Cholangiopancreatography and Inpatient Mortality in Acute Cholangitis: A Systematic Review and Meta-Analysis. Clinical and Translational Gastroenterology (2020).
3. Antibiotic Administration within Two Days after Successful Endoscopic Retrograde Cholangiopancreatography Is Sufficient for Mild and Moderate Acute Cholangitis. Journal of Clinical Medicine (2022).