title: Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines.
abstract: This article discusses the definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis. Acute cholangitis and cholecystitis mostly originate from stones in the bile ducts and gallbladder. Acute cholecystitis also has other causes, such as ischemia; chemicals that enter biliary secretions; motility disorders associated with drugs; infections with microorganisms, protozoa, and parasites; collagen disease; and allergic reactions. Acute acalculous cholecystitis is associated with a recent operation, trauma, burns, multisystem organ failure, and parenteral nutrition. Factors associated with the onset of cholelithiasis include obesity, age, and drugs such as oral contraceptives. The reported mortality of less than 10% for acute cholecystitis gives an impression that it is not a fatal disease, except for the elderly and/or patients with acalculous disease. However, there are reports of high mortality for cholangitis, although the mortality differs greatly depending on the year of the report and the severity of the disease. Even reports published in and after the 1980s indicate high mortality, ranging from 10% to 30% in the patients, with multiorgan failure as a major cause of death. Because many of the reports on acute cholecystitis and cholangitis use different standards, comparisons are difficult. Variations in treatment and risk factors influencing the mortality rates indicate the necessity for standardized diagnostic, treatment, and severity assessment criteria.
authors.affiliation: First Department of Surgery, Sapporo Medical University School of Medicine, S-1, W-16, Chuo-ku, Sapporo, Hokkaido, 060-8543, Japan.
authors.forename: Yasutoshi
authors.initials: Y
authors.lastname: Kimura
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Takada
authors.forename: Yoshifumi
authors.initials: Y
authors.lastname: Kawarada
authors.forename: Yuji
authors.initials: Y
authors.lastname: Nimura
authors.forename: Koichi
authors.initials: K
authors.lastname: Hirata
authors.forename: Miho
authors.initials: M
authors.lastname: Sekimoto
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yoshida
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Mayumi
authors.forename: Keita
authors.initials: K
authors.lastname: Wada
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Miura
authors.forename: Hideki
authors.initials: H
authors.lastname: Yasuda
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Yamashita
authors.forename: Masato
authors.initials: M
authors.lastname: Nagino
authors.forename: Masahiko
authors.initials: M
authors.lastname: Hirota
authors.forename: Atsushi
authors.initials: A
authors.lastname: Tanaka
authors.forename: Toshio
authors.initials: T
authors.lastname: Tsuyuguchi
authors.forename: Steven M
authors.initials: SM
authors.lastname: Strasberg
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Gadacz
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D002761:Cholangitis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D041881:Cholecystitis, Acute / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D041761:Cholecystolithiasis / Q000150:complications; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology; D012008:Recurrence; D014041:Tokyo