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The role of dominant stenoses in bacterial infections of bile ducts in primary sclerosing cholangitis

Pohl, Juergen; Ring, Axel; Stremmel, Wolfgang; Stiehl, Adolf

European Journal of Gastroenterology & Hepatology: January 2006 - Volume 18 - Issue 1 - p 69-74
Original Articles: Biliary Tract
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Objective Primary sclerosing cholangitis (PSC) is characterized by progressive fibrotic inflammation and strictures of the biliary system. We studied the role of dominant stenoses in bacterial biliary infections and the effect of routine antibiotic administration with cholangiography.

Design A prospective clinical trial without blinding or randomization.

Setting The endoscopy unit in a university hospital.

Participants Fifty patients with PSC entered and finished the study.

Interventions A total of 103 endoscopic retrograde cholangiographies (ERC) was performed in 37 PSC patients with dominant stenosis and 13 controls with PSC but no dominant stenosis. After selective cannulation of the bile duct, bile samples were obtained during each procedure. All patients received systemic antibiotic treatment with ciprofloxacin for one week after ERC.

Results Enteric bacteria were detected in the bile specimens of 15 out of 37 PSC patients (40.5%) with dominant stenosis but never in the absence of dominant stenosis (P=0.004). Positive cultures for enteric bacteria were associated with elevated serum C-reactive protein, high leukocyte counts in bile (P<0.05) and the deterioration of liver function assessed by increasing bilirubin levels during the follow-up period lasting a median of 7 months (P=0.06). Despite the high rate of susceptibility in vitro, ciprofloxacin treatment eradicated enteric bacteria in only two out of 12 cases.

Conclusion Bacterial infection of the bile ducts with dominant stenosis is a frequent finding and may play a role in the progression of PSC. Short-course antibiotic treatment is not very effective in eradicating acteria from the bile ducts.

Department of Internal Medicine IV, Ruprechts Karls University, Heidelberg, Germany

Correspondence to Professor Adolf Stiehl, Department of Internal Medicine IV, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany

Tel: +49 6221 5638707; Fax: +49 6221 564116;

e-mail: adolf_stiehl@med.uni-heidelberg.de

© 2006 Lippincott Williams & Wilkins, Inc.