Cholangitis is inflammation in your bile ducts that, without treatment, can lead to serious health issues.

Cholangitis is a type of liver disease that causes inflammation (swelling) in the bile duct.

The bile ducts carry bile from the liver and gallbladder to the small intestine. Bile is a fluid that helps your body digest and absorb fats. It also helps clear waste from the liver.

When the bile ducts become inflamed or blocked, bile can back up into the liver. This can lead to liver damage and other problems.

There are many forms of cholangitis, including:

  • primary sclerosing cholangitis (PSC)
  • primary biliary cholangitis (PBC)
  • IgG4-related autoimmune cholangitis

Cholangitis can also be chronic (long term), where it develops slowly over time, or acute (short term), where it comes on suddenly.

Some forms of cholangitis are mild. Others can be serious and life threatening.

Symptoms depend on what kind of cholangitis you have and how long you’ve had it. Every person who develops cholangitis may have slightly different signs and symptoms. Many people who get cholangitis may not notice any symptoms.

Some early symptoms of chronic cholangitis may include:

  • fatigue
  • itchy skin
  • dry eyes
  • dry mouth

If you have chronic cholangitis for a long time, you may have:

  • pain in the upper right side
  • night sweats
  • swollen feet and ankles
  • darkening of the skin (hyperpigmentation)
  • muscle pain
  • bone or joint pain
  • bloating (fluid in the stomach area)
  • xanthomas (fat deposits) in the skin around the eyes and eyelids
  • fat deposits in the elbows, knees, palms, and soles of the feet
  • diarrhea or greasy bowel movements
  • clay-colored bowel movements
  • weight loss
  • mood changes and memory problems

If you have acute cholangitis, you may also have other, more sudden symptoms, such as:

Your doctor may find signs of cholangitis in other parts of the body. These include:

There is a range of potential causes for cholangitis. And sometimes, there is no known cause.

Chronic cholangitis may be an autoimmune disease. This means that your body’s own immune system mistakenly attacks the bile ducts, causing inflammation.

Over time, this inflammation can trigger scars or the growth of hard tissue inside the bile ducts. The scarring can make bile ducts hard and narrow. It can also block smaller ducts.

Causes of acute cholangitis include:

  • a bacterial infection
  • gallstones
  • blockages
  • tumor

Environmental causes of both acute and chronic cholangitis include:

  • infections (bacteria, virus, fungi, or parasites)
  • smoking
  • chemicals

Risk factors that might increase your chance of developing cholangitis include:

Your doctor can diagnose cholangitis with various types of tests and scans. They may order one or more of the following blood tests:

  • Complete blood count (CBC): Doctors use a CBC blood test to measure your white blood cell count. If you have an infection, your white blood cell count will likely be elevated.
  • Liver function tests: Liver function tests can help determine whether your liver is functioning properly and your liver enzymes are within a normal range.
  • Antimitochondrial antibody (AMA) test: The presence of AMAs and results of other blood work may indicate cholangitis.
  • Cholesterol test: This can help determine your risk factor for gallstones, which can lead to cholangitis.
  • Blood culture: A blood culture test can tell your doctor whether you have a blood infection.

Several types of imaging tests can help your doctor understand how your liver and bile duct are working. Although imaging tests aren’t always necessary, they can help your doctor confirm a diagnosis or rule out other conditions that may have similar symptoms.

These imaging tests may include:

  • Ultrasound: An ultrasound uses high frequency sound waves to capture live images inside your body. It allows your doctor to see any potential issues with your organs and blood vessels without making an incision. For diagnosing cholangitis, an ultrasound will focus on your liver, gallbladder, and bile ducts.
  • CT scan: A CT scan is a form of X-ray that creates detailed images of your internal organs and body structures. For diagnosing cholangitis, a medical professional may inject a dye intravenously to show whether there is a blockage in the bile ducts.
  • Magnetic resonance cholangiopancreatography: This is a special type of MRI that provides detailed pictures of your liver, gallbladder, and bile ducts. It can also show whether there are gallstones in your bile duct or any type of blockage.
  • Endoscopic retrograde cholangiopancreatography: This procedure combines an X-ray and the use of a long, flexible tube with a light and camera on the end, called an endoscope. Your doctor will guide the scope down your throat into your stomach and then into the first part of your intestine. This will allow them to view your organs for any problems. They will then inject a dye into your bile ducts and take an X-ray to see if there is a blockage.
  • Percutaneous transhepatic cholangiography: With this procedure, a medical professional injects a contrasting agent (dye) through your skin into your liver or bile duct. Then, you’ll get an X-ray of the ducts to determine whether there’s an obstruction. Because of the invasive nature of this procedure, doctors use it a lot less frequently than the procedures listed above.

You might also need other tests, such as urine, bile, or stool samples.

Treatments for chronic and acute cholangitis may vary based on the cause. Treatment also depends on how early you receive a diagnosis.

Without treatment, both chronic and acute cholangitis can lead to serious complications.

Early treatment is especially important for acute cholangitis. Your doctor may recommend antibiotics, such as penicillin, ceftriaxone, metronidazole, or ciprofloxacin, for up to 10 days.

They may also recommend procedures in the hospital, such as intravenous (IV) fluids and bile duct drainage.

Unlike acute cholangitis, no medications are available to treat chronic cholangitis. A drug called ursodeoxycholic acid may help protect the liver. It works by improving bile flow, but it doesn’t treat cholangitis itself.

Treatment and care for chronic cholangitis include:

  • managing symptoms
  • monitoring liver function
  • procedures to open blocked bile ducts

Doctors can also use various procedures for both chronic and acute cholangitis:

  • Endoscopic therapy: Doctors may use balloon dilation to open up the ducts and increase bile flow. This helps improve and prevent symptoms. You may need this therapy several times to treat cholangitis. Doctors may also use endoscopic therapy for sphincterotomy (a procedure that cuts the muscle between the common bile duct and pancreatic duct) or stent placement. With endoscopic therapy, you may need full anesthesia or a degree of sedation that sometimes requires intubation to protect the airway.
  • Percutaneous therapy: This is similar to endoscopic therapy, but it’s through the skin. Your doctor will numb the area or put you to sleep before the procedure.
  • Surgery: Your doctor may remove the blocked part of the bile duct. Or, you may have stents put in to open or drain the bile ducts. You’ll be under full anesthesia (asleep) for surgery.
  • Liver transplant: In serious cases, you may need a liver transplant. Your doctor will replace your damaged liver with a new one. You’ll need to take antirejection drugs for the rest of your life after the surgery. This helps your body keep the new liver healthy.

You may also need treatment for some serious side effects of cholangitis:

  • Nutrition: Cholangitis can affect digestion and how your body absorbs some vitamins. You may need vitamin A, D, E, and K supplements.
  • Bone weakness: Your doctor may prescribe medications for osteoporosis. Calcium and vitamin D supplements can help improve bone density and strength.
  • High blood pressure: Your doctor may monitor and treat high blood pressure in the liver, which is called portal hypertension.

Cholangitis can lead to serious health problems without treatment. Potential complications include:

  • Liver problems: Cholangitis can cause liver scarring (cirrhosis). This can slow liver function or lead to liver failure. It also increases the risk of liver cancer. It can cause liver swelling and high blood pressure.
  • Gallstones: Blocked bile can harden into gallstones. This may cause pain and infections.
  • Enlarged spleen: If the liver isn’t working properly and can’t filter out wastes and toxins, old blood cells can collect in the spleen, causing it to swell.
  • Enlarged veins: High blood pressure in the liver may put too much pressure on veins in the stomach. This can lead to swollen and broken veins. It may also cause bleeding.
  • Blood infection: Acute cholangitis can lead to sepsis (a blood infection). This can damage several parts of the body and may be life threatening if not treated.

There is also a link between chronic cholangitis and other conditions, including thyroid problems, scleroderma, and rheumatoid arthritis.

The signs and symptoms of cholangitis will vary from person to person, and the cause may be unclear in some cases. You can’t always prevent cholangitis.

Early treatment can help you have a better outcome. It also helps to prevent symptoms and complications. Get medical attention as soon as possible if you have any symptoms, such as:

  • fever
  • abdominal pain
  • yellowing of the eyes and skin
  • changes in digestion and bowel movements

You may not have any symptoms at all. Regular checkups can help you learn about your liver health with a simple blood test.

Some types of cholangitis may be easier to clear up with treatment. Take all medications as prescribed and consult your doctor for all follow-up appointments.

You can help prevent complications with the necessary daily lifestyle measures, such as not smoking. A balanced diet with plenty of fiber may also ease cholangitis symptoms and help prevent complications. Talk with your doctor or nutritionist about the best diet plan for you.

Find answers to these common questions about cholangitis.

What is the main cause of cholangitis?

Cholangitis is most often due to a bacterial infection in the bile ducts. This may occur as a result of a blockage or infection.

How long does it take to recover from cholangitis?

Around 90% of people who develop acute cholangitis respond to treatment within 48 hours.

Chronic cholangitis doesn’t go away, but treatment is still necessary to help improve symptoms, prevent complications, and protect your health.

What is the life expectancy of cholangitis?

Life expectancy for people with the condition varies based on factors like which type you have, how long you’ve had it, and how quickly you started treatment. Early treatment can help improve outcomes, prevent symptoms, and avoid serious health complications.

Cholangitis is a liver disease that involves inflammation of the bile duct system. Some types of cholangitis are mild. Other kinds can be serious and life threatening.

Chronic cholangitis happens slowly over time. Acute cholangitis, on the other hand, happens suddenly and usually causes symptoms over a short period. These symptoms can include a high fever, nausea, chills, pain in the abdomen, and dark urine.

Cholangitis can lead to serious health problems without treatment. That’s why it’s important to get medical attention if you have any symptoms and schedule regular checkups with your doctor to ensure your liver and bile ducts are working properly.