Why do many patients with hepatobiliary disease itch

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.

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