Digestive Diseases and Sciences

, Volume 42, Issue 5, pp 1094–1099 | Cite as

Pruritus in Chronic Hepatitis C (Association with High Serum Bile Acids, Advanced Pathology, and Bile Duct Abnormalities)

  • Edward Lebovics
  • Fayez Seif
  • David Kim
  • Abdelmonem Elhosseiny
  • Brad M. Dworkin
  • Ana Casellas
  • Susan Clark
  • William S. Rosenthal
Article

Abstract

Pruritus is a common symptom of chroniccholestatic liver diseases but is considered rare inchronic hepatitis. We observed pruritus to be anunusually common complaint in patients with advancedchronic hepatitis C. We reviewed the records of 175chronic hepatitis C patients to identify patients withsevere, diffuse, unexplained pruritus; 12 consecutiveprospective patients undergoing liver biopsy for chronic hepatitis C served as controls.Assessment included laboratory biochemical tests andassessment of liver pathology by stage, grade, hepaticactivity index, and a bile duct score. Pruritus waspresent in nine (5.1%) patients. Serum AST, ALT,alkaline phosphatase, GGTP, total bilirubin, andferritin were similar in pruritics and controls.Pruritics had higher serum bile acids (2028.4 ±223.1 mmol/liter vs 423.1 ± 194.3, P < 0.001), highertransferrin saturation (57.5 ± 6.8% vs 33.2± 3.3, P < 0.01), and lower HCV RNA by bDNA(24.5 ± 12.7 ± 10 vs 172.7 ± 54.1× 105, P < 0.05). Pathology revealedcirrhosis in 6/9 (66.6%) pruritics vs 1/12 (8.3%) controls (P < 0.01).Pruritics had higher pathologic stage (3.7 ± 0.2vs 2.2 ± 0.4, P < 0.01), grade (4.4 ±0.2 vs 2.1 ± 0.2, P < 0.001), activity index(14.3 ± 1.9 vs 8.6 ± 1.9, P < 0.025),and bile duct score (7.6 ± 0.6 vs 4.7 ± 0.4, P <0.01). Of eight pruritics treated withIFN-α2b, two had complete ALT responseand one relapsed. Pruritus followed a relapsing courseand only three patients partially responded despite a variety of interventions. Inconclusion, pruritus is a common complication ofadvanced CHC. Its presence is associated with high serumbile acids, advanced pathology and bile ductabnormalities. The clinical course of pruritus is relapsingand response to therapy is inconsistent. These featuressuggest that pruritus in CHC has a pathogenesis that mayvary from that of chronic cholestaticdiseases.

PRURITUS CHRONIC HEPATITIS C BILE ACIDS CIRRHOSIS 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

REFERENCES

  1. 1.
    Bergasa NV, Jones EA: Management of the pruritus of cholestasis: potential role of opiate antagonists. Am J Gastroenterol 86:1404-1412, 1991Google Scholar
  2. 2.
    Ghent CN, Bloomer JR: Itch in liver disease: facts and speculation. Yale J Biol Med 52:77-82, 1979Google Scholar
  3. 3.
    Bergasa NV, Alling DW, Talbot TL, Swaim MG, Yurdaydin C, Turner ML, et al: Effects of naloxone infusions in patients with the pruritus of cholestasis: A double-blind, randomized, controlled trial. Ann Intern Med 123:161-167, 1995Google Scholar
  4. 4.
    Ludwig J: The nomenclature of chronic active hepatitis: An obituary. Gastroenterology 105:274-278, 1993Google Scholar
  5. 5.
    Knodell RG, Ishak KG, Black WC, Chen TS, Craig R, Kaplowitz N, et al: Formulation and application of a numerical scoring system for assessing histological activity in asymptomatic chronic active hepatitis. Hepatology 1:431-435, 1981Google Scholar
  6. 6.
    Lefkowitch JH, Schiff ER, Davis GL, Perrillo RP, Lindsay K, Bodenheimer HC, et al: Pathological diagnosis of chronic hepatitis C: A multicenter comparative study with chronic hepatitis B. Gastroenterology 104:595-603, 1993Google Scholar
  7. 7.
    Daoud MS, Gibson LE, Daoud S, El-Azhary RA: Chronic hepatitis C and skin diseases: A review. Mayo Clin Proc 70:559-564, 1995Google Scholar
  8. 8.
    Fisher DA, Wright TL: Pruritus as a symptom of hepatitis C. J Am Acad Dermatol 30:629-632, 1994Google Scholar
  9. 9.
    DiBisceglie AM, Axiotis CA, Hoofnagle JH, Bacon BR: Measurement of iron status in patients with chronic hepatitis. Gastroenterology 102:2108-2113, 1992Google Scholar
  10. 10.
    Gretch DR, dela Rosa C, Carithers RL, Willson RA, Williams B, Corey L: Assessment of hepatitis C viremia using molecular amplification technologies: Correlations and clinical implications. Ann Intern Med 123:321-329, 1995Google Scholar
  11. 11.
    Nuovo GJ, Lidonnici K, MacConnell P, Lane B: Intracellular localization of polymerase chain reaction (PCR)-amplified hepatitis C cDNA. Am J Surg Pathol 17:683-690, 1993Google Scholar
  12. 12.
    Mosnier J-F, Scoazec J-Y, Marcellin P, Degott C, Benhamou J-P, Feldmann G: Expression of cytokine-dependent immune adhesion molecules by hepatocytes and bile duct cells in chronic hepatitis C. Gastroenterology 107:1457-1468, 1994Google Scholar
  13. 13.
    Kaji K, Nakanuma Y, Sasaki M, Unoura M, Kobayashi K, Nomomura A: Hepatic bile duct injuries in chronic hepatitis C: Histopathologic and immunohistochemical studies. Mod Pathol 7:937-945, 1994Google Scholar
  14. 14.
    Davis GL: Prediction of response to interferon treatment of chronic hepatitis C. J Hepatol 21:1-3, 1994Google Scholar
  15. 15.
    Rofail MZ, Lewis JH, Seeff LB: Pruritus and chronic hepatitis C. Gastroenterology 108:A1156, 1995Google Scholar
  16. 16.
    Gumber SC, Chopra S: Hepatitis C: A multifaceted disease. Ann Intern Med 123:615-620, 1995Google Scholar
  17. 17.
    Maddrey W, van Thiel DH: Liver transplantation: an overview. Hepatology 8:948-959, 1988Google Scholar

Copyright information

© Plenum Publishing Corporation 1997

Authors and Affiliations

  • Edward Lebovics
  • Fayez Seif
  • David Kim
  • Abdelmonem Elhosseiny
  • Brad M. Dworkin
  • Ana Casellas
  • Susan Clark
  • William S. Rosenthal

There are no affiliations available

Personalised recommendations