Pruritus in cholestatic and other liver diseases
Version of Record online: 26 MAR 2003
Alimentary Pharmacology & Therapeutics
Volume 17, Issue 7, pages 857–870, April 2003
How to Cite
Mela, M., Mancuso, A. and Burroughs, A. K. (2003), Pruritus in cholestatic and other liver diseases. Alimentary Pharmacology & Therapeutics, 17: 857–870. doi: 10.1046/j.1365-2036.2003.01458.x
- Issue online: 26 MAR 2003
- Version of Record online: 26 MAR 2003
- Accepted for publication 25 November 2002
Pruritus is often the most troublesome symptom in patients with chronic liver disease, particularly when cholestasis is a prominent feature.
The exact pathogenesis is unknown, but empirical treatment, such as cholestyramine, based on a liver-based origin of pruritus, has been used for many years. Recently, evidence for a central mechanism for pruritus has been obtained and opioid antagonists have been tried clinically with some benefit, but their use is not widespread. In addition, the pruritus associated with intrahepatic cholestasis of pregnancy can now be alleviated in many cases by ursodeoxycholic acid. As it also improves foetal outcome, this should become first-line therapy.
We review the pathogenesis and therapy of pruritus, highlighting practical aspects to help with patients with seemingly intractable pruritus.