Pathogenesis and management of pruritus in cholestatic liver disease

Journal of Gastroenterology and Hepatology (Australia)

Volumn 27, Issue 7, 2012, Pages 1150-1158

  Imam, Mohamad H ^a   Gossard, Andrea A ^a   Sinakos, Emmanouil ^a   Lindor, Keith D ^a  

^a MAYO CLINIC ROCHESTER   (United States)

Author keywords

Cholestatic; Itch; Liver; Pruritus

Indexed keywords

BILE SALT; COLESTYRAMINE; DIPHENHYDRAMINE; HISTAMINE; LYSOPHOSPHATIDIC ACID; NALOXONE; NALTREXONE; OBETICHOLIC ACID; OPIATE; PLACEBO; PROGESTERONE; RIFAMPICIN; SERTRALINE; URSODEOXYCHOLIC ACID;

ABDOMINAL PAIN; ANOREXIA; CONSTIPATION; CONTINUOUS INFUSION; DECREASED APPETITE; DIARRHEA; DIZZINESS; DRY EYE; FATIGUE; FEVER; FLUSHING; GASTROINTESTINAL SYMPTOM; HEADACHE; HEMOLYTIC ANEMIA; HUMAN; INTRAHEPATIC CHOLESTASIS; KIDNEY FAILURE; LIVER TOXICITY; MALABSORPTION; NAUSEA; PATHOGENESIS; PRIMARY BILIARY CIRRHOSIS; PRIMARY SCLEROSING CHOLANGITIS; PRIORITY JOURNAL; PRURITUS; RASH; REVIEW; SIDE EFFECT; THROMBOCYTOPENIA; VISUAL HALLUCINATION; VOMITING; XEROSTOMIA;

EID: 84862676605     PISSN: 08159319     EISSN: 14401746     Source Type: Journal    
DOI: 10.1111/j.1440-1746.2012.07109.x     Document Type: Review

References (75)

1. Zein CO, Lindor KD. Latest and emerging therapies for primary biliary cirrhosis and primary sclerosing cholangitis. Curr. Gastroenterol. Rep. 2010; 12: 13-22.
2. Rishe E, Azarm A, Bergasa NV. Itch in primary biliary cirrhosis: a patients' perspective. Acta Derm. Venereol. 2008; 88: 34-7.
3. Bergasa NV, Mehlman JK, Jones EA. Pruritus and fatigue in primary biliary cirrhosis. Bailliere's Best Pract. Res. Clin. Gastroenterol. 2000; 14: 643-55.
4. Pathak B, Sheibani L, Lee RH. Cholestasis of pregnancy. Obstet. Gynecol. Clin. North Am. 2010; 37: 269-82.
5. Bergasa NV. The itch of liver disease. Semin. Cutan. Med. Surg. 2011; 30: 93-8.
6. McMahon SB, Koltzenburg M. Itching for an explanation. Trends Neurosci. 1992; 15: 497-501.
7. Tuckett RP. Itch evoked by electrical stimulation of the skin. J. Invest. Dermatol. 1982; 79: 368-73.
8. Ochoa J, Torebjork E. Sensations evoked by intraneural microstimulation of C nociceptor fibres in human skin nerves. J. Physiol. 1989; 415: 583-99.
9. Schmelz M, Schmidt R, Bickel A, Handwerker HO, Torebjork HE. Specific C-receptors for itch in human skin. J. Neurosci. 1997; 17: 8003-8.
10. Schmelz M, Schmidt R, Weidner C, Hilliges M, Torebjork HE, Handwerker HO. Chemical response pattern of different classes of C-nociceptors to pruritogens and algogens. J Neurophysiol. 2003; 89: 2441-8.
11. Patel KN, Dong X. Itch: cells, molecules, and circuits. ACS Chem. Neurosci. 2011; 2: 17-25.
12. Imamachi N, Park GH, Lee H etal. TRPV1-expressing primary afferents generate behavioral responses to pruritogens via multiple mechanisms. Proc. Natl. Acad. Sci. USA 2009; 106: 11330-5.
13. Hashimoto T, Ohata H, Momose K. Itch-scratch responses induced by lysophosphatidic acid in mice. Pharmacology 2004; 72: 51-6.
14. Kremer AE, Martens JJ, Kulik W etal. Lysophosphatidic acid is a potential mediator of cholestatic pruritus. Gastroenterology 2010; 139: 1008-18. 1018 e1001.
15. Oude Elferink RP, Kremer AE, Martens JJ, Beuers UH. The molecular mechanism of cholestatic pruritus. Dig. Dis. 2011; 29: 66-71.
16. Schoenfield LJSJ, Perman E. Bile acids on the skin of patients with pruritic hepatobiliary disease. Nature 1967; 213: 93-4.
17. Hofmann AF, Huet PM. Nasobiliary drainage for cholestatic pruritus. Hepatology 2006; 43: 1170-1.
18. Ng VL, Ryckman FC, Porta G etal. Long-term outcome after partial external biliary diversion for intractable pruritus in patients with intrahepatic cholestasis. J. Pediatr. Gastroenterol. Nutr. 2000; 30: 152-6.
19. Freedman MR, Holzbach RT, Ferguson DR. Pruritus in cholestasis: no direct causative role for bile acid retention. Am. J. Med. 1981; 70: 1011-16.
20. Lloyd-Thomas HG, Sherlock S. Testosterone therapy for the pruritus of obstructive jaundice. Br. Med. J. 1952; 2: 1289-91.
21. Murphy GM, Ross A, Billing BH. Serum bile acids in primary biliary cirrhosis. Gut 1972; 13: 201-6.
22. Fiorucci S, Clerici C, Antonelli E etal. Protective effects of 6-ethyl chenodeoxycholic acid, a farnesoid X receptor ligand, in estrogen-induced cholestasis. J. Pharmacol. Exp. Ther. 2005; 313: 604-12.
23. Bigliardi PL, Tobin DJ, Gaveriaux-Ruff C, Bigliardi-Qi M. Opioids and the skin-where do we stand? Exp. Dermatol. 2009; 18: 424-30.
24. Greaves MW. Pathogenesis and treatment of pruritus. Curr. Allergy Asthma Rep. 2010; 10: 236-42.
25. Miyoshi M, Sakurai T, Kodama S. Clinical evaluation of urinary leukotriene E4 levels in children with atopic dermatitis. Arerugi 1999; 48: 1148-52.
26. Yamamoto A, Sugimoto Y. Involvement of peripheral mu opioid receptors in scratching behavior in mice. Eur. J. Pharmacol. 2010; 649: 336-41.
27. Blunk JA, Schmelz M, Zeck S, Skov P, Likar R, Koppert W. Opioid-induced mast cell activation and vascular responses is not mediated by mu-opioid receptors: an in vivo microdialysis study in human skin. Anesth. Analg. 2004; 98: 364-70. table of contents.
28. Bergasa NV. Treatment of the pruritus of cholestasis. Curr. Treat. Options Gastroenterol. 2004; 7: 501-8.
29. Jones EA, Bergasa NV. The pruritus of cholestasis: from bile acids to opiate agonists. Hepatology 1990; 11: 884-7.
30. Bergasa NV, Vergalla J, Swain MG, Jones EA. Hepatic concentrations of proenkephalin-derived opioids are increased in a rat model of cholestasis. Liver 1996; 16: 298-302.
31. Spivey JR, Jorgensen RA, Gores GJ, Lindor KD. Methionine-enkephalin concentrations correlate with stage of disease but not pruritus in patients with primary biliary cirrhosis. Am. J. Gastroenterol. 1994; 89: 2028-32.
32. Gittlen SD, Schulman ES, Maddrey WC. Raised histamine concentrations in chronic cholestatic liver disease. Gut 1990; 31: 96-9.
33. Jones EA, Bergasa NV. Evolving concepts of the pathogenesis and treatment of the pruritus of cholestasis. Can. J. Gastroenterol. 2000; 14: 33-40.
34. Reyes H, Sjovall J. Bile acids and progesterone metabolites in intrahepatic cholestasis of pregnancy. Ann. Med. 2000; 32: 94-106.
35. Glantz A, Marschall HU, Mattsson LA. Intrahepatic cholestasis of pregnancy: relationships between bile acid levels and fetal complication rates. Hepatology 2004; 40: 467-74.
36. Meng LJ, Reyes H, Axelson M etal. Progesterone metabolites and bile acids in serum of patients with intrahepatic cholestasis of pregnancy: effect of ursodeoxycholic acid therapy. Hepatology 1997; 26: 1573-9.
37. Glantz A, Reilly SJ, Benthin L, Lammert F, Mattsson LA, Marschall HU. Intrahepatic cholestasis of pregnancy: amelioration of pruritus by UDCA is associated with decreased progesterone disulphates in urine. Hepatology 2008; 47: 544-51.
38. Patrick DL, Bush JW, Chen MM. Methods for measuring levels of well-being for a health status index. Health Serv. Res. 1973; 8: 228-45.
39. Yosipovitch G, Zucker I, Boner G, Gafter U, Shapira Y, David M. A questionnaire for the assessment of pruritus: validation in uremic patients. Acta Derm. Venereol. 2001; 81: 108-11.
40. Darsow U, Scharein E, Simon D, Walter G, Bromm B, Ring J. New aspects of itch pathophysiology: component analysis of atopic itch using the "Eppendorf Itch Questionnaire." Int. Arch. Allergy Immunol. 2001; 124: 326-31.
41. Elman S, Hynan LS, Gabriel V, Mayo MJ. The 5-D itch scale: a new measure of pruritus. Br. J. Dermatol. 2010; 162: 587-93.
42. Lindor KD, Gershwin ME, Poupon R, Kaplan M, Bergasa NV, Heathcote EJ. Primary biliary cirrhosis. Hepatology 2009; 50: 291-308.
43. Mitchell SA, Bansi DS, Hunt N, Von Bergmann K, Fleming KA, Chapman RW. A preliminary trial of high-dose ursodeoxycholic acid in primary sclerosing cholangitis. Gastroenterology 2001; 121: 900-7.
44. Shi J, Li Z, Zeng X, Lin Y, Xie WF. Ursodeoxycholic acid in primary sclerosing cholangitis: meta-analysis of randomized controlled trials. Hepatol. Res. 2009; 39: 865-73.
45. Dinler G, Kocak N, Yuce A, Gurakan F, Ozen H. Ursodeoxycholic acid therapy in children with cholestatic liver disease. Turk. J. Pediatr. 1999; 41: 91-8.
46. Narkewicz MR, Smith D, Gregory C, Lear JL, Osberg I, Sokol RJ. Effect of ursodeoxycholic acid therapy on hepatic function in children with intrahepatic cholestatic liver disease. J. Pediatr. Gastroenterol. Nutr. 1998; 26: 49-55.
47. Duncan JS, Kennedy HJ, Triger DR. Treatment of pruritus due to chronic obstructive liver disease. Br. Med. J. 1984; 289: 22.
48. Di Padova C, Tritapepe R, Rovagnati P, Rossetti S. Double-blind placebo-controlled clinical trial of microporous cholestyramine in the treatment of intra- and extra-hepatic cholestasis: relationship between itching and serum bile acids. Methods Find. Exp. Clin. Pharmacol. 1984; 6: 773-6.
49. Feramisco JD, Berger TG, Steinhoff M. Innovative management of pruritus. Dermatol. Clin. 2010; 28: 467-78.
50. Mela M, Mancuso A, Burroughs AK. Review article: pruritus in cholestatic and other liver diseases. Aliment. Pharmacol. Ther. 2003; 17: 857-70.
51. Levy C, Lindor KD. Current management of primary biliary cirrhosis and primary sclerosing cholangitis. J. Hepatol. 2003; 38 (Suppl. 1): S24-37.
52. Khurana S, Singh P. Rifampin is safe for treatment of pruritus due to chronic cholestasis: a meta-analysis of prospective randomized-controlled trials. Liver Int. 2006; 26: 943-8.
53. Mercadante S, Villari P, Fulfaro F. Rifampicin in opioid-induced itching. Support. Care Cancer 2001; 9: 467-8.
54. Price TJ, Patterson WK, Olver IN. Rifampicin as treatment for pruritus in malignant cholestasis. Support. Care Cancer 1998; 6: 533-5.
55. Martinez E, Collazos J, Mayo J. Hypersensitivity reactions to rifampin. Pathogenetic mechanisms, clinical manifestations, management strategies, and review of the anaphylactic-like reactions. Medicine (Baltimore) 1999; 78: 361-9.
56. Yerushalmi B, Sokol RJ, Narkewicz MR, Smith D, Karrer FM. Use of rifampin for severe pruritus in children with chronic cholestasis. J. Pediatr. Gastroenterol. Nutr. 1999; 29: 442-7.
57. Prince MI, Burt AD, Jones DE. Hepatitis and liver dysfunction with rifampicin therapy for pruritus in primary biliary cirrhosis. Gut 2002; 50: 436-9.
58. Yue J, Peng R, Chen J, Liu Y, Dong G. Effects of rifampin on CYP2E1-dependent hepatotoxicity of isoniazid in rats. Pharmacol. Res. 2009; 59: 112-19.
59. Phan NQ, Bernhard JD, Luger TA, Stander S. Antipruritic treatment with systemic mu-opioid receptor antagonists: a review. J. Am. Acad. Dermatol. 2010; 63: 680-8.
60. Bergasa NV, Alling DW, Talbot TL etal. Effects of naloxone infusions in patients with the pruritus of cholestasis. A double-blind, randomized, controlled trial. Ann. Intern. Med. 1995; 123: 161-7.
61. Wolfhagen FH, Sternieri E, Hop WC, Vitale G, Bertolotti M, Van Buuren HR. Oral naltrexone treatment for cholestatic pruritus: a double-blind, placebo-controlled study. Gastroenterology 1997; 113: 1264-9.
62. Zellos A, Roy A, Schwarz KB. Use of oral naltrexone for severe pruritus due to cholestatic liver disease in children. J. Pediatr. Gastroenterol. Nutr. 2010; 51: 787-9.
63. Bergasa NV. Pruritus in primary biliary cirrhosis: pathogenesis and therapy. Clin. Liver Dis. 2008; 12: 385-406. x.
64. Mayo MJ, Handem I, Saldana S, Jacobe H, Getachew Y, Rush AJ. Sertraline as a first-line treatment for cholestatic pruritus. Hepatology 2007; 45: 666-74.
65. Eschler DC, Klein PA. An evidence-based review of the efficacy of topical antihistamines in the relief of pruritus. J. Drugs Dermatol. 2010; 9: 992-7.
66. Pares A, Herrera M, Aviles J, Sanz M, Mas A. Treatment of resistant pruritus from cholestasis with albumin dialysis: combined analysis of patients from three centers. J. Hepatol. 2010; 53: 307-12.
67. Alallam A, Barth D, Heathcote EJ. Role of plasmapheresis in the treatment of severe pruritus in pregnant patients with primary biliary cirrhosis: case reports. Can. J. Gastroenterol. 2008; 22: 505-7.
68. Heathcote EJ. Management of primary biliary cirrhosis. The American Association for the Study of Liver Diseases practice guidelines. Hepatology 2000; 31: 1005-13.
69. Ananthanarayanan M, Balasubramanian N, Makishima M, Mangelsdorf DJ, Suchy FJ. Human bile salt export pump promoter is transactivated by the farnesoid X receptor/bile acid receptor. J. Biol. Chem. 2001; 276: 28857-65.
70. Pellicciari R, Fiorucci S, Camaioni E etal. 6alpha-ethyl-chenodeoxycholic acid (6-ECDCA), a potent and selective FXR agonist endowed with anticholestatic activity. J. Med. Chem. 2002; 45: 3569-72.
71. Neuschwander-Tetri BA, Brunt EM, Wehmeier KR, Sponseller CA, Hampton K, Bacon BR. Interim results of a pilot study demonstrating the early effects of the PPAR-gamma ligand rosiglitazone on insulin sensitivity, aminotransferases, hepatic steatosis and body weight in patients with non-alcoholic steatohepatitis. J. Hepatol. 2003; 38: 434-40.
72. Song KH, Li T, Owsley E, Strom S, Chiang JY. Bile acids activate fibroblast growth factor 19 signaling in human hepatocytes to inhibit cholesterol 7alpha-hydroxylase gene expression. Hepatology 2009; 49: 297-305.
73. Inagaki T, Choi M, Moschetta A etal. Fibroblast growth factor 15 functions as an enterohepatic signal to regulate bile acid homeostasis. Cell Metab. 2005; 2: 217-25.
74. Lindor KD. Farnesoid X receptor agonists for primary biliary cirrhosis. Curr. Opin. Gastroenterol. 2011; 27: 285-8.
75. Mason A, Lv LK, Hirschfield G etal. Farnesoid -X receptor agonists: a new class of drugs for the treatment of pbc. J. Hepatol. 2010; 52 (Suppl): S1-S2.