Treatment of resistant pruritus from cholestasis with albumin dialysis: Combined analysis of patients from three centers

Parés, Albert; Herrera, Manuel Herrera; Avilés, J.; Sanz, María; Mas, Antoni

doi:10.1016/j.jhep.2010.02.031

Cited by 106 publications

(72 citation statements)

References 30 publications

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“…These might include central sensitization of pruriceptors, which may allow for nonpruritogenic stimuli to be perceived as pruritus, and disturbed central neurotransmission in concert with an individual genetic predisposition [9,27,28]. Bile acid removal was high in all children and similar to that reported in adults [19][20][21]23]. In contrast, bilirubin removal was low and related to the low pretreatment serum levels.…”

Section: Discussionmentioning

confidence: 64%

“…MARS appears particularly suitable for patients with cholestatic pruritus not yet suffering from severe coagulopathy, as, in contrast to plasmapheresis, removal of protein-bound hepatic toxins is achieved without exposure of the patient to foreign proteins. Several reports in adults and a single case report in a child suggest relief of pruritus by MARS [19][20][21][22][23][24]. However, in face of the high costs and technical burden, MARS is still infrequently applied.…”

Section: Introductionmentioning

confidence: 99%

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Molecular Adsorbents Recirculating System dialysis in children with cholestatic pruritus

et al. 2011

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Section: Discussionmentioning

confidence: 64%

Section: Introductionmentioning

confidence: 99%

Molecular Adsorbents Recirculating System dialysis in children with cholestatic pruritus

et al. 2011

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“…In 2010, the Barcelona Clinic reported results in 20 patients, most receiving 7 h of treatment on two consecutive days. All but one experienced relief from pruritus [4]. Significant decreases in bile acid level in 41% initially and 37% after 1 month were recorded, and intensity of itching correlated with total bile acid level prior to therapy.…”

mentioning

confidence: 89%

Extracorporeal devices for treatment of refractory pruritus in cholestatic liver disease

Williams

2017

Hepatol Int

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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.

show abstract

Treatment of resistant pruritus from cholestasis with albumin dialysis: Combined analysis of patients from three centers

Cited by 106 publications

References 30 publications

Molecular Adsorbents Recirculating System dialysis in children with cholestatic pruritus

Molecular Adsorbents Recirculating System dialysis in children with cholestatic pruritus

Extracorporeal devices for treatment of refractory pruritus in cholestatic liver disease

Pathogenesis and Management of Pruritus in PBC and PSC

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