Cholangitis classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amandeep Singh M.D.[2], Vendhan Ramanujam M.B.B.S [3], Farwa Haideri [4]


Acute cholangitis may be classified into grade I, II, or III, depending on the severity of the condition.


The severity of cholangitis can be classified into three grades, based on the onset of organ dysfunction and the patient's response to the initial medical treatment:[1][2][3]

  • Mild (grade I)
  • Moderate (grade II)
  • Severe (grade III)

The severity assessment criteria for acute cholangitis according to Tokyo guidelines is as follows:[4][5][6]

Severity assessment of cholangitis
Criterion Severity
Mild (grade I) Moderate (grade II) Severe (grade III)
Onset of organ dysfunction +
Response to medical treatment +

Grade I acute cholangitis

Grade I, or mild acute cholangitis, don't meet the criteria of neither grade II (moderate) nor grade III (severe) acute cholangitis. The patient responds to initial medical treatment.

Grade II acute cholangitis

Grade II, or moderate acute cholangitis, is characterized by the presence of any two of the following:

Grade III acute cholangitis

Grade III, or severe acute cholangitis, is characterized by the onset of dysfunction in at least one of the following:


  1. Wada K, Takada T, Kawarada Y, Nimura Y, Miura F, Yoshida M, Mayumi T, Strasberg S, Pitt HA, Gadacz TR, Büchler MW, Belghiti J, de Santibanes E, Gouma DJ, Neuhaus H, Dervenis C, Fan ST, Chen MF, Ker CG, Bornman PC, Hilvano SC, Kim SW, Liau KH, Kim MH (2007). "Diagnostic criteria and severity assessment of acute cholangitis: Tokyo Guidelines". J Hepatobiliary Pancreat Surg. 14 (1): 52–8. doi:10.1007/s00534-006-1156-7. PMC 2784515. PMID 17252297.
  2. Zimmer V, Lammert F (June 2015). "Acute Bacterial Cholangitis". Viszeralmedizin. 31 (3): 166–72. doi:10.1159/000430965. PMC 4569195. PMID 26468310.
  3. Lee JG (September 2009). "Diagnosis and management of acute cholangitis". Nat Rev Gastroenterol Hepatol. 6 (9): 533–41. doi:10.1038/nrgastro.2009.126. PMID 19652653.
  4. Mayumi, T.; Someya, K.; Ootubo, H.; Takama, T.; Kido, T.; Kamezaki, F.; Yoshida, M.; Takada, T. (2013). "Progression of Tokyo Guidelines and Japanese Guidelines for management of acute cholangitis and cholecystitis". J UOEH. 35 (4): 249–57. PMID 24334691.
  5. Takada T, Strasberg SM, Solomkin JS, Pitt HA, Gomi H, Yoshida M, Mayumi T, Miura F, Gouma DJ, Garden OJ, Büchler MW, Kiriyama S, Yokoe M, Kimura Y, Tsuyuguchi T, Itoi T, Gabata T, Higuchi R, Okamoto K, Hata J, Murata A, Kusachi S, Windsor JA, Supe AN, Lee S, Chen XP, Yamashita Y, Hirata K, Inui K, Sumiyama Y (2013). "TG13: Updated Tokyo Guidelines for the management of acute cholangitis and cholecystitis". J Hepatobiliary Pancreat Sci. 20 (1): 1–7. doi:10.1007/s00534-012-0566-y. PMID 23307006.
  6. Dinc T, Kayilioglu SI, Coskun F (2017). "Evaluation and Comparison of Charcot's Triad and Tokyo Guidelines for the Diagnosis of Acute Cholangitis". Indian J Surg. 79 (5): 427–430. doi:10.1007/s12262-016-1512-z. PMID 29089703.

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