Epidemiology

Acute cholangitis is relatively uncommon, presenting as a complication in less than 10% of patients admitted to hospital with cholelithiasis.[8]​ The male-to-female ratio is equal.[9]​ The average age of presentation is between 50 and 60 years.[9]​ In the US, cholangitis is most commonly seen in Latin American and American Indian people.[9]​ About 0.5% to 2.4% of patients develop cholangitis after endoscopic retrograde cholangiopancreatography, usually due to inadequate steps taken to ensure biliary drainage.[10]​ Recurrent oriental pyogenic cholangitis is more common in the eastern hemisphere than in the western hemisphere.​​[11]

Risk factors

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age >50 years

Presents more commonly in older people.[16]​ The average age of presentation is between 50 and 60 years.[9]

cholelithiasis

Leads to common bile duct obstruction.[10]​​

benign stricture

Leads to common bile duct obstruction.[10][12]

malignant stricture

Leads to common bile duct obstruction.[10][12]

post-procedure injury of bile ducts

Surgical, endoscopic, or radiological intervention can result in inadequate biliary drainage or contamination of the biliary tree leading to common bile duct stricture and obstruction.[10][12]

history of primary sclerosing cholangitis

Leads to common bile duct stricture and obstruction.[10]

history of secondary sclerosing cholangitis

Leads to common bile duct stricture and obstruction.[10]

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HIV infection

HIV is a risk factor for cholangitis, but patients with HIV infection also often develop HIV cholangiopathy, which can have similar laboratory findings but a much less acute presentation. Cholangitis in HIV infection is less common with the use of highly active antiretroviral therapy.[17]

immune checkpoint inhibitors

Immune checkpoint inhibitors, immunotherapy drugs used in the treatment of various cancers, are associated with a variety of gastrointestinal side effects, including cholangitis.[18][19]​ In the majority of cases this is an immune-mediated cholangitis, with portal inflammation, bile duct injuries, and ductular reactions, that responds to immunosuppressive treatment.​[19]

IgG4-related disease

Cholangitis is the most common manifestation of immunoglobulin G4 (IgG4)-related hepatobiliary disease.[20]​ This is usually responsive to treatment with glucocorticoids.[20]

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