Pruritus in chronic cholestatic liver diseases

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Abstract

Pruritus can be a prominent symptom  in patients with chronic liver disorders, especially those  with cholestasis,  and  substantially  affects  quality  of life. Management of pruritus  in cholestatic  liver diseases  remains  a  complicated   medical  problem. The review article deals with pathophysiological mechanisms of pruritus in cholestatic liver diseases, in particular, with the role of bile acids, endogenous opioids, serotonin, and histamine. There is new data on the key pathophysiological elements, such as neuronal activation lysophosphatidic acid and autotaxin, an enzyme that produces lysophosphatidic acid and whose serum activity is associated with the intensity of pruritus. Pathophysiology-based management approaches include administration of anionic exchange resin cholestyramine, ursodeoxycholic acid, rifampicin agonists, an opioid antagonist naltrexone and a  serotonin-reuptake inhibitor sertraline. These agents are recommended for the use as a stepped treatment algorithm. Patients who do not respond to these therapies can become candidates for albumin dialysis, plasmapheresis, ultraviolet B phototherapy, or need some other individualized approaches. New knowledge on the pathophysiology of pruritus may potentially result in the development of new agents for cholestatic pruritus.

About the authors

E. V. Vinnitskaya

Moscow Clinical Scientific Center, Moscow Healthcare Department

Author for correspondence.
Email: e.vinnitskaya@mknc.ru

Vinnitskaya Elena V. – MD, PhD, Head of Research Department of Hepatology.

86 Shosse Entuziastov, Moscow, 111123, +7 (909) 905 90 42

Russian Federation

Yu. G. Sandler

Moscow Clinical Scientific Center, Moscow Healthcare Department

Email: fake@neicon.ru

Sandler Yuliya G. – MD, PhD, Senior Research Fellow, Research Department of Hepatology.

86 Shosse Entuziastov, Moscow, 111123

Russian Federation

V. A. Keyan

Moscow Clinical Scientific Center, Moscow Healthcare Department

Email: fake@neicon.ru

Keyan Vitaliya A. – Research Fellow, Research Department of Hepatology.

86 Shosse Entuziastov, Moscow, 111123

Russian Federation

T. Yu. Khaymenova

Moscow Clinical Scientific Center, Moscow Healthcare Department

Email: fake@neicon.ru

Khaymenova Tat'yana Yu. – MD, PhD, Head of Department of Chronic Liver Disorders.

86 Shosse Entuziastov, Moscow, 111123

Russian Federation

E. A. Orlova

Moscow Clinical Scientific Center, Moscow Healthcare Department

Email: fake@neicon.ru

Orlova Elizaveta A. – Resident, Department of Chronic Liver Disorders.

86 Shosse Entuziastov, Moscow, 111123

Russian Federation

A. V. Polukhina

Moscow Clinical Scientific Center, Moscow Healthcare Department

Email: fake@neicon.ru

Polukhina Anastasiya V. – Research Fellow, Research Department of Hepatology.

86 Shosse Entuziastov, Moscow, 111123

Russian Federation

L. N. Gendrikson

Moscow Clinical Scientific Center, Moscow Healthcare Department

Email: fake@neicon.ru

Gendrikson Larisa N. – MD, PhD, Senior Research Fellow, Research Department of Hepatology.

86 Shosse Entuziastov, Moscow, 111123

Russian Federation

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Copyright (c) 2017 Vinnitskaya E.V., Sandler Y.G., Keyan V.A., Khaymenova T.Y., Orlova E.A., Polukhina A.V., Gendrikson L.N.

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