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Cholestatischer Pruritus

Hepatisch bedingter Juckreiz kann schrecklich hartnäckig sein

Management of pruritus in patients with cholestatic liver disease

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MMW - Fortschritte der Medizin Aims and scope

Bei cholestatischen Lebererkrankungen tritt oft Juckreiz auf, insbesondere bei Störungen der Gallesekretion oder des Galleflusses. Bei stärkerer Intensität reduziert er die Lebensqualität drastisch. Gerade ein quälender nächtlicher Pruritus kann zu schweren Schlafstörungen mit depressiven Verstimmungen führen. Trotz neuerer Erkenntnisse in der Pathophysiologie kann in einigen Fällen medikamentös keine befriedigende Symptomlinderung erreicht werden.

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Literatur

  1. EASL Clinical Practice Guidelines: Management of cholestatic liver diseases. J Hepatol. 2009;51:237–67

  2. Yosipovitch G, Bernhard JD. Clinical practice. Chronic pruritus. N Engl J Med. 2013;368:1625–34

    Article  CAS  PubMed  Google Scholar 

  3. Geenes V, Chappell LC, Seed PT et al. Association of severe intrahepatic cholestasis of pregnancy with adverse pregnancy outcomes: a prospective population-based case-control study. Hepatology. 2014;59:1482–91

    Article  PubMed  PubMed Central  Google Scholar 

  4. Kremer AE, Oude Elferink RP, Beuers U. Pathophysiology and current management of pruritus in liver disease. Clin Res Hepatol Gastroenterol. 2011;35:89–97

    Article  CAS  PubMed  Google Scholar 

  5. McPhedran NT, Henderson RD. Pruritus and Jaundice. Can Med Assoc J. 1965;92:1258–60

    CAS  PubMed  PubMed Central  Google Scholar 

  6. Jones EA, Bergasa NV. Evolving concepts of the pathogenesis and treatment of the pruritus of cholestasis. Can J Gastroenterol. 2000;14:33–40

    Article  PubMed  Google Scholar 

  7. Kremer AE, Beuers U, Oude-Elferink RP, Pusl T. Pathogenesis and treatment of pruritus in cholestasis. Drugs. 2008;68:2163–82

    Article  CAS  PubMed  Google Scholar 

  8. Abu-Hayyeh S, Ovadia C, Lieu T et al. Prognostic and mechanistic potential of progesterone sulfates in intrahepatic cholestasis of pregnancy and pruritus gravidarum. Hepatology. 2016;63:1287–98

    Article  CAS  PubMed  Google Scholar 

  9. Kremer AE, Martens JJ, Kulik W et al. Lysophosphatidic acid is a potential mediator of cholestatic pruritus. Gastroenterology. 2010;139:1008–18

    Article  CAS  PubMed  Google Scholar 

  10. Kremer AE, van Dijk R, Leckie P et al. Serum autotaxin is increased in pruritus of cholestasis, but not of other origin, and responds to therapeutic interventions. Hepatology. 2012;56:1391–400

    Article  CAS  PubMed  Google Scholar 

  11. Lindor KD, Gershwin ME, Poupon R et al. Primary biliary cirrhosis. Hepatology. 2009;50:291–308

    Article  PubMed  Google Scholar 

  12. Stapelbroek JM, van Erpecum KJ, Klomp LW et al. Nasobiliary drainage induces long-lasting remission in benign recurrent intrahepatic cholestasis. Hepatology. 2006;43:51–3

    Article  PubMed  Google Scholar 

  13. Beuers U, Gerken G, Pusl T. Biliary drainage transiently relieves intractable pruritus in primary biliary cirrhosis. Hepatology. 2006;44:280–1

    Article  PubMed  Google Scholar 

  14. Hegade VS, Krawczyk M, Kremer AE et al. The safety and efficacy of nasobiliary drainage in the treatment of refractory cholestatic pruritus: a multicentre European study. Aliment Pharmacol Ther. 2016;43:294–302

    Article  CAS  PubMed  Google Scholar 

  15. Cies JJ, Giamalis JN. Treatment of cholestatic pruritus in children. Am J Health Syst Pharm. 2007;64:1157–62

    Article  CAS  PubMed  Google Scholar 

  16. Gong Y, Huang Z, Christensen E, Gluud C. Ursodeoxycholic acid for patients with primary biliary cirrhosis: an updated systematic review and meta-analysis of randomized clinical trials using Bayesian approach as sensitivity analyses. Am J Gastroenterol. 2007;102:1799–807

    Article  CAS  PubMed  Google Scholar 

  17. Kuiper EM, van Erpecum KJ, Beuers U et al. The potent bile acid sequestrant colesevelam is not effective in cholestatic pruritus: Results of a double-blind, randomized, placebo-controlled trial. Hepatology. 2010;52:1334–40

    Article  CAS  PubMed  Google Scholar 

  18. Beuers U, Kremer AE, Bolier R, Elferink RP. Pruritus in cholestasis: facts and fiction. Hepatology. 2014;60:399–407

    Article  CAS  PubMed  Google Scholar 

  19. Tandon P, Rowe BH, Vandermeer B, Bain VG. The efficacy and safety of bile Acid binding agents, opioid antagonists, or rifampin in the treatment of cholestasis-associated pruritus. Am J Gastroenterol. 2007;102:1528–36.

    Article  CAS  PubMed  Google Scholar 

  20. Mayo MJ, Handem I, Saldana S et al. Sertraline as a first-line treatment for cholestatic pruritus. Hepatology. 2007;45:666–74

    Article  CAS  PubMed  Google Scholar 

  21. Lens S, Leoz M, Nazal L et al. Bezafibrate normalizes alkaline phosphatase in primary biliary cirrhosis patients with incomplete response to ursodeoxycholic acid. Liver Int. 2014;34:197–203

    Article  CAS  PubMed  Google Scholar 

  22. Kumagai H, Ebata T, Takamori K et al. Effect of a novel kappa-receptor agonist, nalfurafine hydrochloride, on severe itch in 337 haemodialysis patients: a Phase III, randomized, double-blind, placebo-controlled study. Nephrol Dial Transplant. 2010;25:1251–7

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Medizinische Klinik 1 — Gastroenterologie, Hepatologie, Pneumologie & Endokrinologie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Ulmenweg 18, D-91054, Erlangen, Deutschland

    Andreas E. Kremer

  2. http://www.springermedizin.de

    M. R. Kraus

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  1. Andreas E. Kremer
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  2. M. R. Kraus
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Correspondence to Andreas E. Kremer.

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Kremer, A.E., Kraus, M.R. Hepatisch bedingter Juckreiz kann schrecklich hartnäckig sein. MMW - Fortschritte der Medizin 158, 64–67 (2016). https://doi.org/10.1007/s15006-016-8449-9

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  • DOI: https://doi.org/10.1007/s15006-016-8449-9

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