**3. Approach to eosinophilic cholangitis**

#### **3.1 Introduction**

Now that we have established the approach towards obstructive jaundice. We will dig deeper into eosinophilic cholangitis.

EC is an uncommon, benign, self-limiting cause of biliary structure characterized by transmural eosinophilic infiltration of the biliary tree which may result in obstructive jaundice. The severity and prognosis vary considerably and may affect part or the entire biliary tree mimicking malignancy [5].

### **3.2 Pathogenesis**

The exact pathogenesis is poorly understood.

The cause of eosinophilic cholangitis is unknown. In some reports, hypereosinophilic syndrome (HES) has been mentioned as possible cause. The diagnosis of hypereosinophilic syndrome is based on the following criteria [6]:


Since all reported cases do not appear to have completely met the criteria for HES, the relationship between eosinophilic cholangitis and HES is uncertain.

An allergic mechanism is thought to play a key role in the development of eosinophilic cholangitis, hence the name. In most reported cases, there was an increased level of IgE, interleukin 5, or eosinophilic cationic protein. The latter is one of the major cationic granules released by activated eosinophils and is the most

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*Eosinophilic Cholangitis*

**3.3 Clinical presentation**

ing that this disease [9]:

by jaundice.

• Abdominal mass

• Abdominal pain

• Generalized fatigue

• Nausea and vomiting

So where do we go from there?

• A liver function test:

• Jaundice

• Weight loss

**3.4 Investigations**

cancer?

done.

*DOI: http://dx.doi.org/10.5772/intechopen.86004*

had normal eosinophilic count.

to differentiate from malignancy such as:

leave liver transplantation as the only cure [7, 8].

• Slightly more prevalent in men than women (1,6:1).

widely used clinical biomarker of eosinophil in atopic diseases. Furthermore, it has been it has been demonstrated that eosinophils produce transforming growth factor-beta, a cytokine known to stimulate fibrosis, a devastating effect that may

Nash et al. conducted a study where they collected around 23 cases of EC reveal-

• The most common presenting symptoms were abdominal pain followed

• Around 69.6% of patients demonstrated peripheral eosinophilia and 30.4%

One of the challenges that accompanies eosinophilic cholangitis is the fact that it can present with a multitude of nonspecific signs and symptoms that makes it hard

At this point, it can be anything and a more in-depth investigation is required.

The issue with eosinophilic cholangitis is that it mimics malignancy very closely so what are the options that we have that can help differentiate it from

Normal routine labs, taking into account the presenting symptoms should be

• CBC with differential to look at the eosinophilic count.

○ Bilirubin (total and direct) may be elevated.

○ ALT and AST may or may not be increased.

widely used clinical biomarker of eosinophil in atopic diseases. Furthermore, it has been it has been demonstrated that eosinophils produce transforming growth factor-beta, a cytokine known to stimulate fibrosis, a devastating effect that may leave liver transplantation as the only cure [7, 8].
