Recurrent episodes of cholangitis:

A. Suggest the presence of undetected or overlooked bile duct pathology.

B. Occur frequently in patients who have indwelling biliary tubes or stents.

C. May be ameliorated by long-term administration of antibiotics.

D. May be associated with the development of secondary biliary cirrhosis. 

DISCUSSION: Cholangitis does not occur in the presence of a normal bile duct system, and all patients with cholangitis have an abnormality. Thus, recurrent episodes of cholangitis signal the need for diagnostic studies. Cholangiography usually will be necessary. The presence of any foreign body in the biliary tract is frequently associated with bactibilia and recurrent episodes of cholangitis. Even a silk suture exposed to the lumen of a bile duct has been known to cause cholangitis. Pigment stone and sludge formation may result from the bacterial deconjugation of bilirubin diglucuronide to bilirubin monoglucuronide, which precipitates as calcium bilirubinate. This material can occlude indwelling tubes and predispose to more frequent episodes of cholangitis. Long-term administration of an oral antibiotic may reduce the frequency and severity of attacks of cholangitis; however, this method of management should not be routine. Correction of the underlying problem is essential. Chronic obstruction and recurrent infection eventually lead to secondary biliary cirrhosis and its complications of portal hypertension, ascites, and bleeding esophageal varices. Once this stage of the disease is reached, correction of the underlying biliary tract problem does not reverse the changes in the liver. Once again, every effort should be made to eliminate the cause of the cholangitis early in the course of disease. The only effective treatment for end-stage liver disease is hepatic transplantation.