Why do many patients with hepatobiliary disease itch?
- Approximately 40% of patients with hepatic cirrhosis demonstrate moderate to severe pruritus.
- The mechanism of pruritus associated with hepatobiliary disease has not been firmly established, but is likely caused by elevated levels of bile acids secondary to cholestasis.
- Serum bile acids are frequently elevated in patients with hepatobiliary disease and pruritus, and bile acid–binding resins relieve the pruritus.
- Studies on purified bile salts placed on blister bases have shown that all bile salts produced pruritus, but unconjugated chenodeoxycholate is the most potent.
