Definitions, pathophysiology, and epidemiology of acute cholangitis and cholecystitis: Tokyo Guidelines

Yasutoshi Kimura, Tadahiro Takada, Yoshifumi Kawarada, Yuji Nimura, Koichi Hirata, Miho Sekimoto, Masahiro Yoshida, Toshihiko Mayumi, Keita Wada, Fumihiko Miura, Hideki Yasuda, Yuichi Yamashita, Masato Nagino, Masahiko Hirota, Atsushi Tanaka, Toshio Tsuyuguchi, Steven M. Strasberg, Thomas R. Gadacz

Research output: Contribution to journalArticlepeer-review

176 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)15-26
Number of pages12
JournalJournal of Hepato-Biliary-Pancreatic Surgery
Issue number1
StatePublished - Jan 2007
Externally publishedYes


  • Acute cholecystitis
  • Bile
  • Biliary
  • Biliary infection
  • Cholangitis
  • Gallstones
  • Guidelines

ASJC Scopus subject areas

  • Surgery
  • Hepatology


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