Abstract Idiopathic primary sclerosing cholangitis is but one type of generalized obliterative disease of the Table I Suggested Therapy in Primary Sclerosing Cholangitis and Obliterative Cholangitis Disease Operation Supportive Therapy Primary sclerosing cholangitis Bypass procedure, cholecysto-jejunostomy, Roux-en-y choledocho-jejunostomy, Roux-en-y Antihistamine drugs, steroids, antiantibody serum (?) Obliterative cholangitis Choledochostomy, T tube drainage Antibiotics, cholegogues extrahepatic biliary tract in which the ducts are diffusely thickened and stenotic. With the recent emphasis on antigen-antibody reaction as a cause of human disease, and gastrointestinal disease in particular, evidence is accumulating to support the concept of this autoimmune cause of sclerosing cholangitis. The Schwartzman reaction in animals has produced a chronic inflammation in the biliary tree [6], and the frequent findings of eosinophilia and an abundance of tissue eosinophils and lymphoid aggregates in some biopsy specimens also implicate tissue hypersensitivity. Eight cases of fibrosis and stenosis of the biliary tract found at the Massachusetts General Hospital are reviewed, and an attempt is made to isolate those cases in which autoimmune factors may play a role in etiology. Identification of this group from other cases of Obliterative disease may be of value in predicting prognosis and suggesting optimal surgical and medical management.