title: Diagnostic criteria and severity assessment of acute cholangitis: Tokyo Guidelines.
abstract: Because acute cholangitis sometimes rapidly progresses to a severe form accompanied by organ dysfunction, caused by the systemic inflammatory response syndrome (SIRS) and/or sepsis, prompt diagnosis and severity assessment are necessary for appropriate management, including intensive care with organ support and urgent biliary drainage in addition to medical treatment. However, because there have been no standard criteria for the diagnosis and severity assessment of acute cholangitis, practical clinical guidelines have never been established. The aim of this part of the Tokyo Guidelines is to propose new criteria for the diagnosis and severity assessment of acute cholangitis based on a systematic review of the literature and the consensus of experts reached at the International Consensus Meeting held in Tokyo 2006. Acute cholangitis can be diagnosed if the clinical manifestations of Charcot's triad, i.e., fever and/or chills, abdominal pain (right upper quadrant or epigastric), and jaundice are present. When not all of the components of the triad are present, then a definite diagnosis can be made if laboratory data and imaging findings supporting the evidence of inflammation and biliary obstruction are obtained. The severity of acute cholangitis can be classified into three grades, mild (grade I), moderate (grade II), and severe (grade III), on the basis of two clinical factors, the onset of organ dysfunction and the response to the initial medical treatment. "Severe (grade III)" acute cholangitis is defined as acute cholangitis accompanied by at least one new-onset organ dysfunction. "Moderate (grade II)" acute cholangitis is defined as acute cholangitis that is unaccompanied by organ dysfunction, but that does not respond to the initial medical treatment, with the clinical manifestations and/or laboratory data not improved. "Mild (grade I)" acute cholangitis is defined as acute cholangitis that responds to the initial medical treatment, with the clinical findings improved.
authors.affiliation: Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan.
authors.forename: Keita
authors.initials: K
authors.lastname: Wada
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: Fumihiko
authors.initials: F
authors.lastname: Miura
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yoshida
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Mayumi
authors.forename: Steven
authors.initials: S
authors.lastname: Strasberg
authors.forename: Henry A
authors.initials: HA
authors.lastname: Pitt
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Gadacz
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
authors.forename: Jacques
authors.initials: J
authors.lastname: Belghiti
authors.forename: Eduardo
authors.initials: E
authors.lastname: de Santibanes
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Gouma
authors.forename: Horst
authors.initials: H
authors.lastname: Neuhaus
authors.forename: Christos
authors.initials: C
authors.lastname: Dervenis
authors.forename: Sheung-Tat
authors.initials: ST
authors.lastname: Fan
authors.forename: Miin-Fu
authors.initials: MF
authors.lastname: Chen
authors.forename: Chen-Guo
authors.initials: CG
authors.lastname: Ker
authors.forename: Philippus C
authors.initials: PC
authors.lastname: Bornman
authors.forename: Serafin C
authors.initials: SC
authors.lastname: Hilvano
authors.forename: Sun-Whe
authors.initials: SW
authors.lastname: Kim
authors.forename: Kui-Hin
authors.initials: KH
authors.lastname: Liau
authors.forename: Myung-Hwan
authors.initials: MH
authors.lastname: Kim
mesh_terms: D000208:Acute Disease; D002761:Cholangitis / Q000097:blood / Q000145:classification / Q000175:diagnosis*; D006801:Humans; D011379:Prognosis; D012720:Severity of Illness Index