American Board of Internal Medicine (ABIM) Certification Practice Exam

Which treatment is indicated for IgG4-associated cholangitis?

1. Cholestyramine

2. Glucocorticoids

3. Azathioprine

4. Antibiotics

The correct answer is: Glucocorticoids

The treatment indicated for IgG4-associated cholangitis is glucocorticoids. This condition is part of a broader spectrum of IgG4-related disease, which is characterized by elevated levels of IgG4 and a predilection for affecting various organs, including the bile ducts. Glucocorticoids play a crucial role in managing this condition because they have significant anti-inflammatory and immunosuppressive properties. By addressing the underlying inflammatory process driven by IgG4-related disease, glucocorticoids can help reduce the inflammation in the bile ducts, alleviate obstructive jaundice, and improve symptoms related to cholangitis. Other treatments listed, while useful in different contexts, do not specifically target the pathology of IgG4-associated cholangitis. For instance, cholestyramine is primarily used to manage pruritus associated with cholestasis but does not address the autoimmune component. Azathioprine can be utilized in certain chronic inflammatory conditions but is generally not the first-line treatment for IgG4-associated conditions. Antibiotics may be required if there is a bacterial infection but do not treat the underlying IgG4-related disease itself. Therefore, glucocorticoids are the standard treatment to effectively manage