Pathophysiology and current management of pruritus in liver disease

Clin Res Hepatol Gastroenterol. 2011 Feb;35(2):89-97. doi: 10.1016/j.clinre.2010.10.007.


Pruritus is frequently reported by patients with cholestatic hepatobiliary diseases such as primary biliary cirrhosis, primary sclerosing cholangitis, intrahepatic cholestasis of pregnancy and hereditary cholestatic syndromes, but may accompany almost any other liver disease. Increased concentrations of bile salts, histamine, progesterone metabolites or endogenous opioids have been controversially discussed as potential pruritogens in cholestasis in the past. Most recently, novel insights unravelled lysophosphatidic acid (LPA), a potent neuronal activator, as a potential pruritogen in pruritus of cholestasis. Nevertheless, the pathogenesis of pruritus in cholestasis is still not clearly defined and current antipruritic treatment strategies provide relief only in a part of the affected patients. Based on recent experimental and clinical findings, this review outlines the actual insight in pathogenesis of pruritus in cholestasis and summarizes evidence-based and experimental therapeutic interventions for cholestatic patients suffering from itch.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anticholesteremic Agents / administration & dosage
  • Cholagogues and Choleretics / administration & dosage
  • Cholangitis, Sclerosing / complications
  • Cholestasis, Intrahepatic / complications
  • Drug Therapy, Combination
  • Evidence-Based Medicine
  • Female
  • Humans
  • Liver Cirrhosis, Biliary / complications
  • Liver Diseases / complications*
  • Lysophospholipids / adverse effects
  • Pregnancy
  • Pregnancy Complications / drug therapy
  • Pregnancy Complications / physiopathology
  • Pruritus / drug therapy*
  • Pruritus / etiology
  • Pruritus / physiopathology*
  • Treatment Outcome


  • Anticholesteremic Agents
  • Cholagogues and Choleretics
  • Lysophospholipids