Cholangitis is the term healthcare professionals use to describe inflammation in the bile ducts or biliary system. Some forms of cholangitis can be life threatening.

The biliary system is a part of a person’s digestive system. The role of the biliary system is to produce, store, and secrete bile. It consists of the:

  • liver
  • gallbladder
  • bile ducts

There are different types of cholangitis, with the most common type being acute bacterial cholangitis. This is an ascending bacterial infection of the biliary system caused by infected gallstones that obstruct bile flow. It can be life threatening.

On average, people present with less than 200,000 cases of acute cholangitis in the United States each year.

In this article, we discuss the different types of cholangitis and discuss their symptoms, causes, diagnosis, and treatment, as well as when to see a doctor.

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This section discusses three different types of cholangitis.

Acute bacterial cholangitis

Acute bacterial cholangitis is the name for acute inflammation and bacterial infection of the biliary duct system. This can obstruct the flow of bile through the biliary system. It can also lead to increased bacteria and endotoxins in the lymphatic and vascular systems. Endotoxins are poisonous substances that are present in certain types of bacteria.

This type of cholangitis can cause potentially life threatening complications, such as abscesses in the liver and biliary septicemia.

Primary biliary cholangitis

Primary biliary cholangitis is a chronic condition. It causes inflammation in the small bile ducts in the liver. This type of cholangitis is a progressive disease that gets worse over time. It eventually destroys the bile ducts.

Without functioning bile ducts, bile builds up, which can cause liver damage. In turn, this can cause a person to develop:

Medical professionals believe that primary biliary cholangitis is an autoimmune disease, which means a person’s own immune system mistakenly attacks its healthy bile duct cells.

Primary sclerosing cholangitis

Similar to primary biliary cholangitis, primary sclerosing cholangitis is a chronic disease that causes inflammation and scarring to the bile ducts that are inside, as well as outside, the liver. It worsens over time and eventually narrows or blocks the bile ducts. This causes bile to build up in the liver, which can cause liver damage and potentially lead to cirrhosis and liver failure.

Healthcare professionals believe that primary sclerosing cholangitis is an autoimmune disorder, as well.

Symptoms of cholangitis include:

Certain types of cholangitis may also cause joint pain.

Cholangitis can also lead to a bile duct infection, which can cause the following symptoms:

  • fever
  • chills
  • upper right abdominal pain
  • new or worsening jaundice

This section discusses the causes of the three different types of cholangitis.

Acute bacterial cholangitis

Acute bacterial cholangitis occurs due to a bacterial infection of the biliary system.

This infection most commonly occurs following obstruction of the bile ducts, which most frequently occurs when a gallstone enters the ducts. Healthcare professionals call this choledocholithiasis.

Primary biliary cholangitis

Medical professionals are unsure about exactly what causes primary biliary cholangitis. However, some believe it is an autoimmune disorder.

Additionally, research suggests that some genes may make certain people more likely to develop the condition.

If a person has these specific genes, certain environmental factors may trigger an autoimmune reaction. During this reaction, their immune system attacks the cells in the small bile ducts, leading to primary biliary cholangitis.

Possible environmental triggers include:

Primary sclerosing cholangitis

Healthcare professionals also do not know exactly what causes primary sclerosing cholangitis. However, many believe it is an autoimmune disorder.

Research indicates that the following factors may play a role in the development of the disease:

  • changes in the gut microbiota
  • certain genes
  • bile acids causing injury to the bile ducts
  • problems with the immune system

A doctor will often diagnose cholangitis based on:

Medical history

When checking a person’s medical and family history, a doctor may ask a person whether they have:

Physical exam

A doctor may also carry out a physical exam. During a physical exam, a doctor may:

  • press or tap on certain areas of the abdomen, looking for tender or painful spots, particularly on the upper right side
  • use a stethoscope to listen to sounds in a person’s abdomen
  • check to see if the spleen and liver are larger than expected
  • look for signs of jaundice and other indicators of cirrhosis and liver failure
  • look for any scratch marks where a person may have scratched itchy skin

Imaging tests

A doctor may also use imaging tests to help diagnose cholangitis.

The first-line imaging test for cholangitis is an abdominal ultrasound, which uses sound waves to create images of organs, including the liver and gallbladder.

Ultrasound images can help a doctor diagnose cholangitis by showing:

  • dilation of the bile ducts
  • thickening of the bile duct walls
  • evidence of gallstones and material that causes pus

A doctor may also use other imaging tests, such as CT scans or MRI scans, to look for signs of cholangitis.

Blood tests

A doctor may also use blood tests to help look for signs of cholangitis.

During a blood test, a healthcare professional will take a sample of the person’s blood. They will then send this sample to a lab where a healthcare professional will analyze it. During this analysis, a medical professional may look at the levels of:

Liver biopsy

For some people, a healthcare professional may perform a liver biopsy, in which they take a small amount of tissue from the liver. Another healthcare professional then analyzes the tissue sample under a microscope.

Liver biopsy analysis may reveal signs of other conditions affecting a person’s liver and the extent of any liver damage. It may also help confirm a doctor’s initial diagnosis.


Doctors may also recommend a colonoscopy for a person with primary sclerosing cholangitis. This procedure involves a healthcare professional inserting a small tube with a camera attached into a person’s rectum and large intestine.

A colonoscopy may reveal signs of IBD in some people with primary sclerosing cholangitis.

Healthcare professionals may treat acute bacterial cholangitis with:

A person with cholangitis often has a positive outlook if they start treatment early. However, if there is a significant delay in treatment, the disease can be life threatening.

The Food and Drug Administration (FDA) has approved a medication called ursodiol to treat primary biliary cholangitis. Ursodiol does not cure the disease, but it may slow its progression and help prevent liver damage.

There is currently no standard treatment for primary sclerosing cholangitis. If a person has this type of cholangitis, a doctor may only treat certain symptoms of the disease.

Treating symptoms of cholangitis

Cholangitis may cause blockages or narrowing in the bile ducts. Doctors may treat this with an endoscopic retrograde cholangiopancreatography procedure.

This is a procedure that uses gastrointestinal endoscopy and X-rays to open the bile ducts. A doctor may also use stents, which are small tubes that a doctor leaves in narrow ducts to hold them open.

A healthcare professional may also recommend medications to treat itchy skin.

If a person experiences any symptoms of cholangitis, they should contact a doctor right away. This allows a doctor to make an accurate diagnosis and recommend a suitable treatment plan.

Early diagnosis and early treatment of acute bacterial cholangitis may help improve a person’s outlook. If a person receives delayed treatment, then their condition could become life threatening.

Cholangitis describes inflammation in the bile duct system. There are three types of cholangitis. One occurs due to bacterial infections, and the others may be the result of autoimmune reactions.

Symptoms of cholangitis include fever and chills, jaundice, and itchy skin. Over time, cholangitis can lead to liver damage, cirrhosis, and liver failure.

Treatment for cholangitis may vary depending on the type a person has. A person should contact a healthcare professional as soon as possible if they notice any symptoms of cholangitis. A doctor can determine the root cause of the symptoms and, if a person has cholangitis, recommend appropriate treatment.