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As noted above, the two things that are needed for cholangitis to occur are: 1) obstruction to bile flow, and 2) presence of bacteria within the bile ducts. The most common cause of cholangitis is infection of the bile ducts due to blockage by a gallstone. Strictures (portions of ducts that have become narrow) also function in the same way. Strictures may be due to congenital (birth) abnormalities of the bile ducts, form as a result of injury to the bile duct (such as surgery, trauma), or result from inflammation that leads to scar tissue and narrowing.
The bacterium most commonly associated with infection of the bile ducts is Escherichia coli (E. coli) which is a normal inhabitant of the intestine. In some cases, more than one type of bacteria is involved. Patients with AIDS can develop infection of narrowed bile ducts with unusual organisms such as Cryptosporidium and others.
The three symptoms present in about 70% of patients with cholangitis are abdominal pain, fever, and jaundice. Some patients only have chills and fever with minimal abdominal symptoms. Jaundice or yellow discoloration of the skin and eyes occurs in about 80% of patients. The color change is due to bile pigments that accumulate in the blood and eventually in the skin and eyes.
Inflammation due to the autoimmune disease primary sclerosing cholangitis leads to multiple areas of narrowing and eventual infection. Tumors can block the bile duct and also cause cholangitis, but as noted, infection is relatively infrequent; in fact cholangitis occurs in only about one in six patients with tumors.
Another type of bile duct infection occurs mainly in Southeast Asia and is known as recurrent pyogenic cholangitis or Oriental cholangitis. It has also been identified in Asians immigrating to North America. Most patients have stones in the bile ducts and/or gallbladder, and many cases are associated with the presence of parasites within the ducts. The role of parasites in causing infection is not clear. Many researchers believe that they are just coincidental, and have nothing to do with the stones or infection.
— David Kaminstein, MD
