[Pruritus associated with cholestasis].
Pruritus is commonly associated with cholestatic disorders and shows wide interindividual variability. The presence of skin lesions due to scratching and the application of a visual analogue scale are useful for clinical evaluation. Although the pathophysiology of this entity is not well understood, advances have recently been made in understanding of the pruritoceptive neural pathway, which shares certain similarities with the nociceptive pathway, although there are other distinguishing characteristics such as the action of a specific neurotransmitter, GPR, on the first synapsis at the posterior horn of the spinal cord. Amongst the modulator systems of the pruritoceptive pathway is the action of the endogenous opioids. An increase of these opioids in cholestatic situations is the most widely accepted hypothesis for pruritus in these patients. Some treatments have proven efficacy in randomized clinical trials in patients with cholestatic disorders, such as anion exchange resins, rifampicin, opioid antagonists and ursodeoxycholic acid; the latter is especially useful in intrahepatic cholestasis of pregnancy.
Terán
Alvaro
A
Servicio de Aparato Digestivo, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España. altelan@hotmail.com
Fábrega
Emilio
E
Pons-Romero
Fernando
F
D000818:Animals; D000837:Anion Exchange Resins / Q000627:therapeutic use; D002779:Cholestasis / Q000150:complications* / Q000503:physiopathology; D019317:Evidence-Based Medicine; D005260:Female; D019886:Gastrin-Releasing Peptide / Q000502:physiology; D000882:Haplorhini; D006801:Humans; D008297:Male; D008959:Models, Neurological; D009292:Narcotic Antagonists / Q000627:therapeutic use; D009434:Neural Pathways / Q000503:physiopathology; D018847:Opioid Peptides / Q000502:physiology; D020671:Posterior Horn Cells / Q000502:physiology; D011247:Pregnancy; D011248:Pregnancy Complications / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D011537:Pruritus / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D016032:Randomized Controlled Trials as Topic; D012293:Rifampin / Q000627:therapeutic use; D014580:Ursodeoxycholic Acid / Q000494:pharmacology
D000837:Anion Exchange Resins; D009292:Narcotic Antagonists; D018847:Opioid Peptides; D014580:Ursodeoxycholic Acid; D019886:Gastrin-Releasing Peptide; D012293:Rifampin