Extracorporeal Albumin Dialysis: A Procedure for Prolonged Relief of Intractable Pruritus in Patients with Primary Biliary Cirrhosis

Parés, Albert; Cisneros, Laura; Salmerón, Joan Manuel; Caballería, Llorenç; Mas, Antoni; Torrás, A; Rodés, Juan

doi:10.1111/j.1572-0241.2004.30204.x

Cited by 102 publications

(45 citation statements)

References 29 publications

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“…Plasma bile acids are markedly increased and are responsible, directly or indirectly, for the severe pruritus that occurs in this condition. Pruritus can be treated symptomatically by aspiration of bile [82] or by albumin dialysis which removes plasma bile acids [83]. It may be helped by administration of UDCA or bile acid sequestrants such as cholestyramine, colestipol, or colesevelam.…”

Section: Obstruction To Bile Flowmentioning

confidence: 99%

Bile Acids: Chemistry, Pathochemistry, Biology, Pathobiology, and Therapeutics

Hofmann

Hagey

2008

Cell. Mol. Life Sci.

729

565

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Bile acids and bile alcohols in the form of their conjugates are amphipathic end products of cholesterol metabolism with multiple physiological functions. The great variety of bile acids and bile alcohols that are present in vertebrates are tabulated. Bile salts have an enterohepatic circulation resulting from efficient vectorial transport of bile salts through the hepatocyte and the ileal enterocyte; such transport leads to the accumulation of a pool of bile salts that cycles between the liver and intestine. Bile salt anions promote lipid absorption, enhance tryptic cleavage of dietary proteins, and have antimicrobial effects. Bile salts are signaling molecules, activating nuclear receptors in the hepatocyte and ileal enterocyte, as well as an increasing number of G-protein coupled receptors. Bile acids are used therapeutically to correct deficiency states, to decrease the cholesterol saturation of bile, or to decrease the cytotoxicity of retained bile acids in cholestatic liver disease.

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Section: Obstruction To Bile Flowmentioning

confidence: 99%

Bile Acids: Chemistry, Pathochemistry, Biology, Pathobiology, and Therapeutics

Hofmann

Hagey

2008

Cell. Mol. Life Sci.

729

565

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“…However, MARS was also reported as a valuable and safe procedure for intractable pruritus either after orthotopic liver transplantation or in patients with primary biliary cirrhosis [9][10][11] . To date, 25 cases of successful use of the MARS in patients with refractory pruritus have been reported [9][10][11][12][13] . The mechanisms by which MARS ameliorates pruritus remain unclear.…”

Section: Discussionmentioning

confidence: 99%

Albumin liver dialysis as pregnancy-saving procedure in cholestatic liver disease and intractable pruritus

Lemoine¹,

Revaux²,

Francoz³

et al. 2008

WJG

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Progressive familial intrahepatic cholestasis type 3 (PFIC3) is a rare cholestatic liver disease. Such liver disease can get worse by female hormone disorder. Albumin dialysis or Molecular Adsorbent Recirculating System (MARS) has been reported to reverse severe cholestasis-linked pruritus. Here, we report the first use of MARS during a spontaneous pregnancy and its successful outcome in a patient with PFIC3 and intractable pruritus. Albumin dialysis could be considered as a pregnancy-saving procedure in pregnant women with severe cholestasis and refractory pruritus.

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“…UVB phototherapy may represent an option to alleviate refractory pruritus as outlined in an uncontrolled case series [131] . Furthermore, a beneficial effect of invasive therapeutic procedures such as plasmapheresis [132,133] , MARS ® or Prometheus ® therapy [134][135][136][137] , plasma separation and anion absorption [138] , and nasobiliary drainage [75] with otherwise uncontrollable pruritus has been reported in case series. However, none of the studies was placebo controlled and the techniques are invasive, very elaborate, and too expensive for routine use.…”

Section: Management Of Cholestatic Pruritusmentioning

confidence: 99%

Pathogenesis and Management of Pruritus in PBC and PSC

Kremer¹,

Namer

Bolier

et al. 2015

Dig Dis

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Pruritus is a preeminent symptom in patients with chronic cholestatic liver disorders such as primary biliary cirrhosis and primary sclerosing cholangitis. More than two-thirds of these patients experience itching during the course of their disease. This symptom is also frequently observed in patients with other causes of cholestasis such as cholangiocarcinoma, inherited forms of cholestasis and intrahepatic cholestasis of pregnancy, but may accompany almost any other liver disease. The pathogenesis of pruritus of cholestasis remains largely elusive. Increased concentrations of bile salts, histamine, serotonin, progesterone metabolites and endogenous opioids have been controversially discussed as potential pruritogens. However, for these molecules, neither a correlation with itch intensity nor a causative link could be established. The G protein-coupled receptor for bile salts, TGR5, has been shown to be expressed in dorsal root ganglia and give rise to itch in rodents, albeit upon stimuli with suprapathological concentrations of bile salts. The potent neuronal activator lysophosphatidic acid (LPA) and its forming enzyme, autotaxin (ATX), could be identified in the serum of patients with cholestatic pruritus. ATX activity correlated with itch severity and effectiveness of several anti-pruritic therapeutic interventions in cholestatic patients. Thus, the ATX-LPA-axis may represent a key element in the pathogenesis of this agonizing symptom. Treatment options for pruritus of cholestasis remain limited to a few evidence-based and several experimental medical and interventional therapies. The current guideline-based recommendations include the anion exchange resins colestyramine, the pregnane X receptor-agonist and enzyme inducer rifampicin, the μ-opioid antagonist naltrexone, and the selective serotonin reuptake inhibitors sertraline. Still, a considerable part of patients is unresponsive to these drugs and requires experimental approaches including phototherapy, plasmapheresis, albumin dialysis or nasobiliary drainage. This review outlines the current knowledge on pathogenesis of cholestatic pruritus and summarizes evidence-based and experimental therapeutic interventions for cholestatic patients with itch.

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Extracorporeal Albumin Dialysis: A Procedure for Prolonged Relief of Intractable Pruritus in Patients with Primary Biliary Cirrhosis

Abstract: The ECAD procedure seems to be an effective alternative for the treatment of patients with pruritus of cholestasis who do not respond to other therapeutic methods.

Cited by 102 publications

References 29 publications

Bile Acids: Chemistry, Pathochemistry, Biology, Pathobiology, and Therapeutics

Bile Acids: Chemistry, Pathochemistry, Biology, Pathobiology, and Therapeutics

Albumin liver dialysis as pregnancy-saving procedure in cholestatic liver disease and intractable pruritus

Pathogenesis and Management of Pruritus in PBC and PSC

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