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.
© 2011 John Wiley & Sons A/S.
MeSH terms
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Cholestasis / complications*
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Cholestyramine Resin / therapeutic use
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Humans
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Lysophospholipids / metabolism
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Opioid Peptides / antagonists & inhibitors
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Opioid Peptides / metabolism
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Plasmapheresis / methods*
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Pruritus / diagnosis
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Pruritus / drug therapy*
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Pruritus / metabolism
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Pruritus / physiopathology*
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Pruritus / therapy*
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Renal Dialysis / methods*
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Rifampin / therapeutic use
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Sertraline / therapeutic use
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Sorption Detoxification / methods*
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Ursodeoxycholic Acid / therapeutic use
Substances
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Lysophospholipids
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Opioid Peptides
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Cholestyramine Resin
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Ursodeoxycholic Acid
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lysophosphatidic acid
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Sertraline
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Rifampin