Metabolic Dysfunction-Associated Steatotic Liver Disease and Acute Cholangitis; Hepatobiliary Diseases Are in a Relation

Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is defined by hepatic fat accumulation unrelated to significant alcohol use and is strongly associated with metabolic disorders. It progresses from simple steatosis to inflammation and fibrosis, increasing the risk of cirrhosis and hepatocellular carcinoma. In contrast, acute cholangitis (AC) is a severe biliary infection usually caused by bile duct obstruction—often due to gallstones, strictures, or tumors—and presents with symptoms such as fever, jaundice, and abdominal pain. While both conditions affect liver health, their causes differ. There is pieces of evidence from clinical and experimental studies that shows there could be a relationship between MASLD and AC. It has been demonstrated that MASLD significantly increases AC risk, with worse clinical outcomes, including higher mortality, prolonged hospitalization, and severe complications such as sepsis and acute kidney injury. A piece of evidence has been provided mechanistic insights, showing that MASLD exacerbates cholangitis through chronic inflammation, ductular proliferation, and fibrosis, driven by bile acid (BA) dysregulation and gut-liver axis dysfunction. Studies highlighted BA metabolism disruptions in MASLD, while other studies emphasized the role of metabolic comorbidities and dysbiosis in amplifying biliary inflammation. Collectively, these studies underscore MASLD as a critical risk factor for AC, mediated by metabolic, inflammatory, and biliary pathways. This review aims to explain these connections, offering insights into preventive strategies and therapeutic targets to mitigate AC risk and improve outcomes in MASLD patients.