Extracorporeal devices for treatment of refractory pruritus in cholestatic liver disease

Williams, Roger

doi:10.1007/s12072-017-9802-5

Cited by 1 publication

(3 citation statements)

References 12 publications

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“…The cause of severe pruritus is not well known, neither which is the metabolite to be eliminated. It has been suggested the role of protein-bound toxic substances and it has been proposed the use of charcoal and other adsorbents [8]. Thus, it has been reported clinical response in 9 out of 15 patients (mostly with PBE) treated with Charcoal hemoperfusion with a median of 5 sessions of 4 hours extracorporeal perfusion per week [11].…”

Section: Discussionmentioning

confidence: 99%

“…The pathogenesis of pruritus secondary to cholestatic liver disease has been associated with multiple plasma factors such as neurotransmitters (e.g. histamine, serotonin), bile salts, endogenous opioids, progesterone metabolites or lysophosphatidic acid (LPA) [6,7], but there is no correlation with the severity of the underlying disease and liver structure [8]. Thus, the treatment of cholestasis pruritus is currently based on (i) elimination of mediators of pruritus from the enterohepatic circulation with the use of resins or aspiration with a nasogastric tube, (ii) induction of the metabolism of pruritus mediators in the liver with, for example, rifampicin, and (iii) modulation of the central sedation pathway of pruritus with opioid antagonists or with selective inhibitors of serotonin re-uptake [9].…”

Section: Introductionmentioning

confidence: 99%

“…Thus, the treatment of cholestasis pruritus is currently based on (i) elimination of mediators of pruritus from the enterohepatic circulation with the use of resins or aspiration with a nasogastric tube, (ii) induction of the metabolism of pruritus mediators in the liver with, for example, rifampicin, and (iii) modulation of the central sedation pathway of pruritus with opioid antagonists or with selective inhibitors of serotonin re-uptake [9]. Intractable pruritus is defined by failure on symptoms control despite the sequential regimen with bile acid sequestrants (cholestiramine or clesevelam), enzyme-inducing agents (rifampicin), opioid antagonists (naltrexone) and selective serotonin inhibitors (sertraline) [8]. Currently, correct response to treatment is commonly measured by a visual analogue scale (VAS) or numeric ranged scales (NRS) [10].…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Beyond the kidney: Nephrologists in the treatment of severe chronic pruritus failing to respond to systemic treatments

Codina¹,

R²,

Sandoval³

et al. 2018

Nephrol Renal Dis

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We report a case of severe chronic pruritus in a patient with cholestasic liver disease due to a cholangiocarcinoma that did not respond to sequential treatment with bile acid sequestrants, enzyme-inducing agents, opioid antagonists or selective serotonin inhibitors. Since the cause of severe pruritus is the accumulation of some substances in plasma and other tissues, as a result of cholestasis, it has been suggested that the removal of these substances would improve the quality of life of patients. However, the specific nature of the substances and the mechanisms by which they cause itching is still unknown, meaning that there is no targeted therapy or any guidelines available to tackle this situation. Therefore, therapies for chronic pruritus are largely based on clinical experience and anecdotal reports. Considering that Nephrologists are well trained to perform extracorporeal blood purification treatments, we were requested for an experimental therapy with total plasma exchange (TPE), an invasive therapy that has been claimed as effective. However, this report illustrates a case in which TPE displayed a low clinical benefit and prompted us to review the evidence behind the use of extracorporeal devices in cholestatic liver disease.

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Section: Discussionmentioning

confidence: 99%