Review article: pruritus in cholestatic and other liver diseases.
Pruritus is often the most troublesome symptom in patients with chronic liver disease, particularly when cholestasis is a prominent feature. The exact pathogenesis is unknown, but empirical treatment, such as cholestyramine, based on a liver-based origin of pruritus, has been used for many years. Recently, evidence for a central mechanism for pruritus has been obtained and opioid antagonists have been tried clinically with some benefit, but their use is not widespread. In addition, the pruritus associated with intrahepatic cholestasis of pregnancy can now be alleviated in many cases by ursodeoxycholic acid. As it also improves foetal outcome, this should become first-line therapy. We review the pathogenesis and therapy of pruritus, highlighting practical aspects to help with patients with seemingly intractable pruritus.
Mela
M
M
Liver Transplantation and Hepatobiliary Unit, Royal Free Hospital, London, UK.
Mancuso
A
A
Burroughs
A K
AK
D000837:Anion Exchange Resins / Q000627:therapeutic use; D000982:Antipruritics / Q000627:therapeutic use; D002756:Cholagogues and Choleretics / Q000627:therapeutic use; D006801:Humans; D008107:Liver Diseases / Q000150:complications* / Q000188:drug therapy; D009292:Narcotic Antagonists / Q000627:therapeutic use; D017294:Ondansetron / Q000627:therapeutic use; D011537:Pruritus / Q000188:drug therapy / Q000209:etiology*; D012293:Rifampin / Q000627:therapeutic use; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use
D000837:Anion Exchange Resins; D000982:Antipruritics; D002756:Cholagogues and Choleretics; D009292:Narcotic Antagonists; D017294:Ondansetron; D014580:Ursodeoxycholic Acid; D012293:Rifampin