title: Extracorporeal artificial liver support systems in the management of intractable cholestatic pruritus.
abstract: Pruritus can occur as a severe complication of cholestasis. Several hypotheses suggest an important role for the accumulation of bile acids, endogenous opioids and - mire recently - lysophosphatidic acid. Bile acid sequestrants are the first-line therapeutic agents. In refractory cases, a stepwise approach using rifampicin, oral opiate antagonists and the selective serotonin reuptake inhibitor sertraline should be tested. Recent case series reported effective relief of pruritus using extracorporal liver support systems and plasmapheresis.
authors.affiliation: Department of Internal Medicine 3, Division of Gastroenterology and Hepatology, Medical University Vienna, Vienna, Austria. valentin.fuhrmann@meduniwien.ac.at
authors.forename: Valentin
authors.initials: V
authors.lastname: Fuhrmann
authors.forename: Andreas
authors.initials: A
authors.lastname: Drolz
authors.forename: Michael
authors.initials: M
authors.lastname: Trauner
mesh_terms: D002779:Cholestasis / Q000150:complications*; D002792:Cholestyramine Resin / Q000627:therapeutic use; D006801:Humans; D008246:Lysophospholipids / Q000378:metabolism; D018847:Opioid Peptides / Q000037:antagonists & inhibitors / Q000378:metabolism; D010956:Plasmapheresis / Q000379:methods*; D011537:Pruritus / Q000175:diagnosis / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology* / Q000628:therapy*; D006435:Renal Dialysis / Q000379:methods*; D012293:Rifampin / Q000627:therapeutic use; D020280:Sertraline / Q000627:therapeutic use; D016060:Sorption Detoxification / Q000379:methods*; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use
chemical_list: D008246:Lysophospholipids; D018847:Opioid Peptides; D002792:Cholestyramine Resin; D014580:Ursodeoxycholic Acid; C032881:lysophosphatidic acid; D020280:Sertraline; D012293:Rifampin