Systemic inflammatory response in acute cholangitis and after subsequent treatment.
OBJECTIVE
To measure the concentrations of endotoxin and inflammatory mediators during an attack of acute cholangitis and see what effect endoscopic treatment had on these mediators.


METHODS
Prospective study.


METHODS
University teaching hospital The Netherlands.


METHODS
Ten patients with acute cholangitis.


METHODS
Measurements were made during the attack and 1 week after endoscopic treatment.


METHODS
Changes in clinical variables, and severity of biliary obstruction. Concentrations of endotoxin, cytokines, and endotoxin binding proteins, in plasma.


RESULTS
The causes of cholangitis were obstructed endoprosthesis (n = 4) and stones (n = 6). The median bilirubin concentration during the attack was 70.0 micromol/L (range 14-156) and 14.5 micromol/L (range 9-80) after treatment (p < 0.05). Median (range) plasma endotoxin concentrations were 3.6 pg/ml (3.2-107) and 3.6 (2.4-5), respectively. Concentrations of cytokines were high during the acute attack and significantly lower after treatment: median tumour necrosis factor (TNF) fell from 44.6 pg/ml (range 1.2-403) to 7.3 (0-53); soluble TNF receptor p55 from 4.9 ng/ml (2.7-13.8) to 3.6 (1.4-8.2) and TNF receptor p75 from 11.6 ng/ml (7.1-40.6) to 8.1 (2.9-31.3); interleukin 6 (IL-6) fell from 690 pg/ml (34.1-4594) to 8.2 (0-39.3), IL-8 from 226.2 pg/ml (31.6-712.7) to 21.4 (4.2-63.5) and IL-10 from 33.4 pg/ml (2.7-5605) to 4.7 (0-16.7) (p < 0.03). Values for lipopolysaccharide binding protein and soluble CD14 also fell significantly (p < 0.01) from 86.5 (43.4-200) to 21.5 (11.3-37.5) and from 200 (59-200) to 47.8 (0.47-200), respectively. The concentration of bactericidal permeability increasing protein did not change significantly, being 7.1 (2-18.9) during the acute attack and 4.6 (0.8-17.7) a week later.


CONCLUSIONS
There is a considerable systemic inflammatory response during cholangitis, which is dramatically reduced one week after endoscopic treatment.
Kimmings
A N
AN
Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.
van Deventer
S J
SJ
Rauws EAJ
Huibregtse
K
K
Gouma
D J
DJ
D000208:Acute Disease; D001424:Bacterial Infections / Q000276:immunology*; D002761:Cholangitis / Q000276:immunology* / Q000382:microbiology / Q000628:therapy; D016207:Cytokines / Q000097:blood*; D004322:Drainage; D004731:Endotoxins / Q000097:blood*; D004797:Enzyme-Linked Immunosorbent Assay; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood*; D011446:Prospective Studies; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000276:immunology*; D013997:Time Factors
D016207:Cytokines; D004731:Endotoxins; D018836:Inflammation Mediators