What is bacterial cholangitis?
Bacterial cholangitis in primary sclerosing cholangitis (PSC) is an infection of the bile ducts requiring urgent medical treatment. It can strike at any time, although it is less common in early disease. It doesn’t mean that your PSC is necessarily progressing; it could just be a ‘blip’. However, it is important for you to be aware of the possible symptoms of a cholangitis attack because it can be a medical emergency necessitating prompt antibiotics to prevent sepsis 22.
Why have I got bacterial cholangitis?
In people with PSC, the immune system ‘attacks’ the bile ducts, causing inflammation, which results in hardening and narrowing of the ducts 22. This means that the bile cannot drain properly and it builds up in the liver. The normally sterile bile can then become infected. When it is infected it is called bacterial cholangitis. Some people refer to it as a ‘flare up’ or a ‘cholangitis attack’.
What are the symptoms of bacterial cholangitis?
Cholangitis complicating PSC frequently does not present with the classic presentation of an infection such as fever, pain, and a high white cell count, and can involve a spectrum of less specific symptoms 1,2. This means that doctors inexperienced with PSC at your local A&E department may not recognise your symptoms as being due to cholangitis.
Symptoms can be variable and should not be ignored.
Some people with PSC say it feels a bit like having flu and symptoms can include:
- itching (pruritus)
- dark urine
- shivers and chills*
- pain in the Upper Right Quadrant (URQ)
- pale stools
- night sweats
*Fever, shivers and chills indicate a serious bacterial infection that needs urgent antibiotic treatment, although not all bacterial infections cause chills. Bacterial cholangitis in PSC may need medical attention even in the absence of fever or chills 2.
What should I do if I suspect bacterial cholangitis?
If you think you have bacterial cholangitis, urgent medical care is required so you will need to be assessed by A&E, your GP or PSC doctor.
Download the bacterial cholangitis leaflet (below) to show to your healthcare provider.
Bacterial cholangitis: top tips
- Keep a note of all your symptoms and how long you have had them.
- Get an urgent appointment with a medical professional.
- Show our leaflet to your doctor.
- Expect to have an urgent blood test.
- Expect to be given a broad-spectrum antibiotic such as ciprofloxacin.
- Contact your usual PSC doctor immediately if you are at all unsure of your treatment or care.
How is bacterial cholangitis treated?
Dr Roger Chapman states that bacterial cholangitis should be: 'treated with the immediate administration broad-spectrum antibiotics such as ciprofloxacin.' 22
Left untreated, bacterial cholangitis can cause serious complications such as severe sepsis 1.
If you are initially treated for cholangitis at A&E, we recommend that you ensure that your PSC doctor is informed as soon as possible. They will consider your individual circumstances, and in some cases, may also consider an MRI scan or endoscopy to investigate and/or help clear your bile ducts.
It is ideal if patients have a strategy to obtain antibiotics promptly as soon as features of bacterial cholangitis develop, such as a prescription at home 2.