Pruritus bij leverziekten

Pathogenesis and treatment

• Pruritus is a severe symptom in patients with cholestatic hepatobiliary disease; it can greatly reduce the quality of life.

• Cholestatic itching often peaks in the evening and early night. It mainly occurs on the palms of the hands and soles of the feet but can also occur more generalised.

• The pathogenesis of cholestatic pruritus has not yet been completely clarified. Possible contributors are bile salts, histamine, progesterone metabolites and opioids. A relationship between these elements and the intensity of the itch has not, however, been demonstrated.

• Autotaxin, an enzyme that produces lysophosphatidic acid, has recently been identified as a possible pruritogen caused by cholestasis.

• Treatment is aimed at eliminating pruritogens with bile acid sequestrants (cholestyramine), managing the metabolism of pruritogens (rifampicin), and influencing the perception of itch by the central nervous system with µ-opioid antagonists or SSRIs.

• In cases of unbearable, treatment-resistant itching, consideration may be given to experimental therapies such as UV light therapy or nasobiliary drainage.

Conflict of interest: U. Beuers has received financial support for lecturing from the Falk Foundation, Gilead, Roche, Schering-Plough and Zambon and has received financial support for research from the German Crohn-Colitis Association, the Norwegian Primary Sclerosing Cholangitis Association and from Zambon. Financial support for this article: none declared.