Citation

Trivedi HD, Lizaola B, Tapper EB, Bonder A. Am. J. Med. 2017; 130(6): 744.e1-744.e7.

Copyright

(Copyright © 2017, Elsevier Publishing)

DOI

10.1016/j.amjmed.2017.01.037

PMID

28238692

Abstract

Primary biliary cholangitis is an autoimmune condition characterized by destruction of intrahepatic bile ducts. It causes debilitating symptoms that dramatically affect the patient's quality of life. Pruritus affects 60% to 70% of individuals with primary biliary cholangitis and leads to sleep disturbances, fatigue, depression, and suicidal ideation. A complete search was performed with studies from PubMed, EMBASE, Web of Science, Cochrane database, Countway Library, and CINAHL with specific search terms. This narrative review was prepared after a comprehensive literature review. Treating patients with cholestatic pruritus is challenging and may have a profound impact on quality of life. The standard of therapy for primary biliary cholangitis, ursodeoxycholic acid, does not have a beneficial effect in cholestatic pruritus. Patients often do not respond to conventional therapies such as cholestyramine, rifampicin, opioid antagonists, and sertraline. These therapies lack long-term efficacy and have side effects. Patients who have not responded to these initial treatments can be considered for experimental therapies or clinical trials. This review outlines the current and emerging treatment modalities for patients with primary biliary cholangitis who have pruritus.

Language: en

Keywords

Humans; Depression; Fatigue; Suicidal Ideation; Quality of Life; Pruritus; Cholestasis; Sleep Wake Disorders; Ursodeoxycholic Acid; Biliary injury; Cholagogues and Choleretics; Cholangitis; Cholestatic pruritus; Primary biliary cholangitis