Cholangitis: Causes, Symptoms, Treatment and Cost

Bile duct inflammation is known as cholangitis. Many symptoms, including fever, stomach ache, jaundice, and black urine, might be brought on by it.

The types of Cholangitis are:

• Primary Sclerosing Cholangitis (PSC): This is an autoimmune condition that affects the liver's bile ducts and is chronic and progressive. It is characterized by inflammation and narrowing of the bile ducts, leading to damage to the liver and other organs.
• Secondary Sclerosing Cholangitis (SSC): This type of cholangitis is caused by an underlying condition such as gallstones, infections, or tumors that block the bile ducts. Symptoms include jaundice, abdominal pain, and itching.
• Primary Biliary Cirrhosis (PBC): This is a chronic condition in which inflammation of the bile ducts causes scarring and damage to the liver cells. If neglected, it may eventually cause cirrhosis and liver failure.
• Secondary Biliary Cirrhosis (SBC): This type of cholangitis is caused by an underlying condition such as hepatitis C or alcohol abuse that causes inflammation of the bile ducts, leading to scarring and damage to the liver cells.
• Ascending Cholangitis: This type of cholangitis occurs when bacteria enter the biliary tree through an obstruction or injury and cause inflammation in the lower part of the common bile duct.

Cholangitis has the following causes:

• Bacterial infection: Bacterial infections such as E. Coli and Klebsiella pneumonia can cause cholangitis if they get into the bile ducts.
• Parasitic infections: Parasitic infections such as liver flukes can cause cholangitis if they block the bile ducts and cause inflammation.
• Stones: Cholangitis may result from bile flow being blocked by stones in the gallbladder or bile ducts.
• Congenital abnormalities: Congenital abnormalities such as a narrowing of the bile ducts or abnormal connections between them can lead to cholangitis.
• Cancer: Cancer of the bile ducts or liver can cause cholangitis due to blockage of the ducts by tumors or metastases (spread of cancer cells).

The symptoms of Cholangitis are:

• Abdominal pain: Cholangitis can cause abdominal pain that is typically located in the right upper quadrant, where the liver and gallbladder are located. Nausea and vomiting that come with this discomfort, which may be minor to severe, are also possible.
• Fever: Cholangitis is an infection of the bile ducts, so it is common for a fever to accompany this condition.
• Jaundice: Jaundice occurs when there is an excess of a type of pigment called bilirubin in the blood, which can give skin and eyes a yellowish tint. This is a common symptom of cholangitis since bile flow may be blocked due to the infection, resulting in a buildup of bilirubin in the blood.
• Dark urine: Dark urine can be caused by cholangitis due to high levels of bilirubin in the bloodstream that are then filtered out through the kidneys and excreted in the urine.
• Clay-colored stool: Clay-colored or pale stools can also result from cholangitis due to high levels of bilirubin in the bloodstream that are then filtered out through the intestines and excreted as waste.

Following are the ways to prevent Cholangitis:

• Practicing good hygiene: Keeping the hands and body clean can help reduce the risk of getting a bacterial infection that can lead to cholangitis.
• Getting vaccinated: Some bacterial and viral diseases that might cause cholangitis are preventable with the use of vaccines.
• Avoiding alcohol: Drinking alcohol increases the risk of developing cholangitis, so avoiding it is an important way to reduce the risk.
• Eating a healthy diet: By giving the body the vital vitamins and minerals it needs to function properly, a balanced diet rich in fruits and vegetables may help lower the incidence of cholangitis.
• Maintaining a healthy weight: A healthy weight is essential for prevention since being overweight or obese increases the chance of getting cholangitis.
• Avoiding certain medications: Some medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), may increase the risk of developing cholangitis, so it’s important to talk to your doctor about any medications you’re taking and their potential risks.

The diagnosis and test of Cholangitis are:

• Physical Examination: This includes a thorough physical examination, a review of the patient's medical history, a look for inflammation, and an evaluation of the patient's general health.
• Blood Tests: Blood tests can be used to check for elevated levels of liver enzymes, which may indicate an infection or inflammation in the bile ducts.
• Imaging Tests: Imaging tests such as an abdominal ultrasound, magnetic resonance cholangiopancreatography (MRCP), or computed tomography (CT) scan can help diagnose cholangitis by identifying any blockages or narrowing of the bile ducts.
• Endoscopic Retrograde Cholangiopancreatography (ERCP): An ERCP is an invasive procedure where a flexible tube is inserted through the mouth and throat to get a better view of the biliary tree. This procedure can be used to identify any blockages in the bile ducts that are causing cholangitis.
• Liver Biopsy: A liver biopsy is an invasive procedure where a small sample of tissue is taken from the liver and examined under a microscope to look for signs of infection or inflammation in the liver.

The possible complication of Cholangitis is:

• Sepsis: A potentially fatal cholangitis complication known as sepsis is brought on by the spread of bacteria and/or their toxins into circulation. Organ damage, shock, and even death might result from it.
• Liver Failure: Severe cases of cholangitis can cause liver failure due to inflammation and damage to the cells of the liver. If it is not immediately and appropriately treated, this might be deadly.
• Abdominal Pain: Cholangitis can cause abdominal pain due to inflamed bile ducts and blockages. The pain may be felt in the upper right side of the abdomen, or it may radiate to other areas such as the shoulder or back.
• Obstructive Jaundice: This occurs when bile ducts become blocked, causing a build-up of bilirubin in the body which leads to jaundice (yellowing of the skin).
• Pancreatitis: Inflammation of the pancreas caused by obstruction from cholangitis biliary tree can cause severe abdominal pain, fever, nausea, and vomiting as well as increased risk for pancreatic cancer.

Home remedies for Cholangitis are:

• Herbal Medicine: Herbal supplements, like Triphala and Punarnava, may help to reduce inflammation and support liver function. Additionally, herbs such as Guduchi (Tinospora cordifolia), Amalaki (Emblica officinalis), and Bhumyamalaki (Phyllanthus amarus) can be taken to help reduce the symptoms of Cholangitis.
• Detoxifying Diet: Eating a diet rich in fruits and vegetables can help detoxify the body and reduce inflammation. Also, avoiding processed meals and choosing organic foods wherever feasible may help the body detoxify itself.
• Ayurvedic Massage Therapy: Ayurvedic massage therapy with medicated oils can help to improve circulation, reduce inflammation, and enhance the detoxification of the body.
• Yoga & Breathing Exercises: Practicing yoga postures and breathing exercises such as Pranayama can help to improve circulation, reduce stress, and improve overall physical health.

The diet to be followed if you are suffering from Cholangitis Disease are:

• Foods that are high in soluble fiber, such as fruits, vegetables, legumes, and oats should be avoided as they can worsen symptoms.
• Foods that are lower in fat and contain more complex carbohydrates are usually recommended, such as lean meats, fish, whole grains, and low-fat dairy products.
• To assist drain bile salts from the body and avoid dehydration, it's vital to consume a lot of water.
• Some people may benefit from taking additional supplements to help with digestion or other health concerns related to cholangitis. These can include probiotics, omega-3 fatty acids, vitamin D3, or glutamine.

Following are the diet to be avoided in Cholangitis:

• Avoid processed, high-fat, and high-sugar foods since they may exacerbate bile duct irritation.
• Limit salt intake: Too much salt can cause fluid retention and raise blood pressure, which can worsen symptoms of cholangitis.
• Avoid caffeine and alcohol: Both of these substances can irritate the liver and bile ducts, leading to a worsening of symptoms.
• Avoid certain spices: Spicy foods are known to trigger cholangitis flare-ups in some people, so it is best to avoid them if possible.
• Avoid dairy products: Dairy products contain fats that may be difficult for the body to digest and can lead to an increase in inflammation in the bile ducts.

The treatment of Cholangitis is given below:

• Percutaneous Transhepatic Biliary Drainage (PTBD): This technique involves passing a catheter, or thin tube, through the skin into the liver and then down into the bile ducts. This procedure is used to drain bile from the blocked ducts and reduce inflammation.
• Endoscopic Retrograde Cholangiopancreatography (ERCP): ERCP is an endoscopic technique that uses an X-ray to view the bile ducts, allowing doctors to identify any blockages or strictures. A catheter can then be passed through the endoscope to dilate the blocked sections of ducts or remove any obstructions such as gallstones.
• Endoscopic Sphincterotomy: Endoscopic sphincterotomy is a procedure in which a small incision is made in the sphincter muscle of the common bile duct during an ERCP procedure. This allows for easier passage of stones and other debris from within the ducts and can help relieve symptoms of cholangitis.
• Surgical Biliary Drainage: If a patient's condition does not respond to less invasive treatments, surgery may be necessary to open up blocked bile ducts and restore the normal flow of bile. During this procedure, surgeons will make an incision in either the abdomen or chest in order to access and repair damaged areas within the biliary tree.

A gastroenterologist is the best doctor to consult for Cholangitis, as they specialize in diseases of the digestive system.

The best medicines for Cholangitis are given below:

• Antibiotics: These drugs are used to treat illnesses brought on by bacteria like Klebsiella pneumoniae or Escherichia coli.Common antibiotics for cholangitis include cephalosporins, fluoroquinolones, and aminoglycosides.
• Anti-inflammatory drugs: These medications reduce inflammation in the bile ducts, improving bile flow and relieving symptoms of cholangitis. Examples include corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs).
• Antiemetics: These medications help reduce nausea and vomiting associated with cholangitis. Common antiemetics include ondansetron (Zofran) and metoclopramide (Reglan).
• Pain relievers: Opioids may be prescribed to manage severe pain associated with cholangitis. Common opioids used for pain relief include oxycodone (OxyContin) and hydrocodone (Vicodin).
• Muscle relaxants: Medications such as cyclobenzaprine (Flexeril) may be given to help ease muscle spasms in the bile ducts that can contribute to the pain of cholangitis.
• Gallstone dissolution agents: If gallstones are contributing to your cholangitis, your doctor may prescribe a medication such as chenodeoxycholic acid (CDCA) or ursodeoxycholic acid (UDCA), which can help dissolve them over time.

Generally speaking, milder cases can take anywhere from a few days to two weeks to fully recover, while more severe cases can take up to four weeks or longer.

No, the results of treatment for cholangitis are not permanent.

While treatments such as antibiotics can help to reduce symptoms and manage the condition, recurrent episodes of cholangitis can still occur.

It is advised to follow up with a doctor on a regular basis to check the disease and make sure that any recurrences are dealt with right away.

The post-treatment guidelines for Cholangitis are:

• Monitor symptoms closely, including abdominal pain, jaundice, fever, and chills.
• Follow dietary guidelines as advised by your doctor, such as reducing fat intake and eating a balanced diet of whole grains and fresh fruits and vegetables.
• Stay away from alcohol and other drugs that can make your situation worse.
• Take any prescription drugs as directed by your doctor in order to control inflammation or maintain bile flow.
• Regular exercise can enhance general health and lower stress levels, which might exacerbate the illness.
• Avoid exposure to toxins or irritants in the environment that could worsen the condition or cause a flare-up of symptoms.
• Follow up with your doctor on a frequent basis for examinations and testing to track advancements in the treatment of the problem.

Depending on the patient's health, the kind of therapy, and the facility delivering the treatment, the cost of cholangiocarcinoma therapies in India varies.

Generally, the cost of basic treatments can range from Rs 10,000 to Rs 25,000. More complex treatments can cost up to Rs 50,000 or more.

The side effects of Cholangitis treatment are:

• Nausea and vomiting: Vomiting and nausea are adverse effects of treatment with antibiotics or other drugs. This can be managed with anti-nausea medications, dietary modifications, and drinking plenty of fluids.
• Diarrhea: Antibiotic use for Cholangitis can cause diarrhea as a side effect. Keep yourself hydrated and talk to your doctor about any new or worsening symptoms.
• Stomach pain: Sometimes people have stomach pain after taking certain medications for Cholangitis, such as antibiotics or antacids. This can usually be managed by changing the dosage or switching to another medication if necessary.
• Fatigue: Fatigue is a common side effect of many treatments for Cholangitis, including antibiotics and other medications that may reduce inflammation in the liver or bile ducts. Getting proper rest and sleep is important for managing mana.
• Headache: Headaches are a possible side effect of some medications used to treat Cholangitis, such as antibiotics or anti-inflammatory drugs. If this occurs, it is important to let your doctor know so they can adjust the dosage if necessary or switch to another medication if needed.

If you have any cholangitis-related consequences, you should see a doctor in your area very far away since they may lead to sepsis, liver failure, stomach discomfort, and other problems for which treatment regimens can last anywhere from a few months to years, depending on how severe the condition is.