Pruritus in chronic cholestatic liver disease

Clin Liver Dis. 2012 May;16(2):331-46. doi: 10.1016/j.cld.2012.03.010.

Abstract

Pruritus is a troublesome complication in patients with cholestatic liver disease. Several links to its pathogenesis have been proposed, including the role of bile acids, endogenous opioid and serotonins, and lysophosphatidic acid. The management of pruritus in cholestasis is challenging. Medical treatment of the underlying cholestatic condition may provide benefit. Extracorporeal albumin dialysis can be pursued for those who have a poor quality of life and failed the various therapeutic interventions, while awaiting liver transplantation. Experimental interventions, and the management of pruritus in certain conditions such as intrahepatic cholestasis of pregnancy and benign recurrent intrahepatic cholestasis, are also briefly reviewed.

Publication types

  • Review

MeSH terms

  • Algorithms
  • Anion Exchange Resins / therapeutic use
  • Antipruritics / therapeutic use
  • Bile Acids and Salts / metabolism
  • Cholestasis / complications*
  • Cholestasis / therapy
  • Chronic Disease
  • Female
  • Histamine Antagonists / therapeutic use
  • Humans
  • Liver Diseases / complications*
  • Liver Diseases / therapy
  • Liver Transplantation
  • Lysophospholipids / metabolism
  • Narcotic Antagonists / pharmacology
  • Narcotic Antagonists / therapeutic use
  • Opioid Peptides / metabolism
  • Phosphoric Diester Hydrolases / metabolism
  • Plasmapheresis
  • Pregnancy
  • Pregnancy Complications / therapy*
  • Pregnane X Receptor
  • Pruritus / etiology*
  • Pruritus / therapy*
  • Receptors, Steroid / agonists
  • Serotonin / metabolism
  • Serotonin Antagonists / therapeutic use
  • Serotonin Uptake Inhibitors / therapeutic use
  • Signal Transduction / drug effects

Substances

  • Anion Exchange Resins
  • Antipruritics
  • Bile Acids and Salts
  • Histamine Antagonists
  • Lysophospholipids
  • Narcotic Antagonists
  • Opioid Peptides
  • Pregnane X Receptor
  • Receptors, Steroid
  • Serotonin Antagonists
  • Serotonin Uptake Inhibitors
  • Serotonin
  • Phosphoric Diester Hydrolases
  • alkylglycerophosphoethanolamine phosphodiesterase
  • lysophosphatidic acid