title: Jaundice associated pruritis: a review of pathophysiology and treatment.
abstract: To review the underlying pathophysiology and currently available treatments for pruritis associated with jaundice. English language literature was reviewed using MEDLINE, PubMed, EMBASE and clinicaltrials.gov for papers and trails addressing the pathophysiology and potential treatments for pruritis associated with jaundice. Recent advances in the understanding of the peripheral anatomy of itch transmission have defined a histamine stimulated pathway and a cowhage stimulated pathway with sensation conveyed centrally via the contralateral spinothalamic tract. Centrally, cowhage and histamine stimulated neurons terminate widely within the thalamus and sensorimotor cortex. The causative factors for itch in jaundice have not been clarified although endogenous opioids, serotonin, steroid and lysophosphatidic acid all play a role. Current guidelines for the treatment of itching in jaundice recommend initial management with biliary drainage where possible and medical management with ursodeoxycholic acid, followed by cholestyramine, rifampicin, naltrexone and sertraline. Other than biliary drainage no single treatment has proved universally effective. Pruritis associated with jaundice is a common but poorly understood condition for which biliary drainage is the most effective therapy. Pharmacological therapy has advanced but remains variably effective.
authors: Ramez Bassari, Jonathan B Koea, Department of Surgery, North Shore Hospital, Takapuna, Auckland 0632, New Zealand.
authors: Ramez
authors: R
authors: Bassari
authors: Ramez Bassari, Jonathan B Koea, Department of Surgery, North Shore Hospital, Takapuna, Auckland 0632, New Zealand.
authors: Jonathan B
authors: JB
authors: Koea
mesh_terms: D000818:Animals; D000982:Antipruritics / Q000627:therapeutic use*; D002756:Cholagogues and Choleretics / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D004322:Drainage / Q000379:methods*; D006801:Humans; D007565:Jaundice / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D009434:Neural Pathways / Q000503:physiopathology; D017410:Practice Guidelines as Topic; D011537:Pruritus / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D000982:Antipruritics; D002756:Cholagogues and Choleretics
keywords: Bile acids; Biliary drainage; Jaundice; Lysophosphatidic acid; Pruritis