Bacterial cholangitis – colloquially called bacterial bile duct inflammation – (synonyms: Acute Cholangitis, Bacterial Cholangitis; Cholangiitis; Purulent Bacterial Cholangitis; Bile Duct Inflammation; Infectious Cholangitis; ICD-10-GM K83.0: Cholangitis) is an inflammation of the extrahepatic and intrahepatic (located outside and inside the liver) bile ducts caused by bacteria, triggered by an obstruction to the outflow of bile.
The disease is most commonly caused by Escherichia coli (gram-negative), Klebsiellae (gram-negative), Enterobacter ssp. (gram-negative), Enterococcus ssp. (gram-positive) and anaerobes such as Bacteroides, Clostridia, in rare cases also by Proteus species, Streptococci, Pseudomonas, Staphylococci. In most cases, these are mixed infections with several germs.
Sex ratio: Women are more frequently affected than men.
Frequency peak: The disease occurs predominantly after the age of 40.
The main cause of bacterial cholangitis is considered to be cholelithiasis (gallstone disease). Gallstones obstruct the drainage of bile and promote the colonization of bacteria in the bile ducts. The prevalence of cholelithiasis is 15% in women and 7.5% in men (in Germany).
Course and prognosis: The disease is easily treatable by removal of the outflow obstruction(s) and antibiotic therapy. Bacterial cholangitis can be mild, but can also be fulminant. If the disease persists for a long time, it can become chronic. If left untreated, the disease takes a life-threatening course. Bacterial cholangitis can be recurrent, especially if the bile ducts are damaged by the inflammatory processes. Anatomic causes also increase the tendency to recur.
Mortality (number of deaths in a given period, based on the number of the population in question) is 3 to 11% with interventional decompression of the bile ducts and antibiotic therapy. If impaired renal function, thrombocytopenia (<100,000/μl/decreased platelet count), or liver cirrhosis (irreversible damage to the liver and marked remodeling of liver tissue) are present, the mortality risk increases.
