Evolving concepts of the pathogenesis and treatment of the pruritus of cholestasis, Pulsus Group Inc
CANADIAN JOURNAL OF GASTROENTEROLOGY & HEPATOLOGY
The Canadian Association of Gastroenterology (CAG) Canadian Association for the Study of the Liver (CASL)

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Mini-Review January 2000, Volume 14 Issue 1: 33-39
 

Evolving concepts of the pathogenesis and treatment of the pruritus of cholestasis

EA Jones | NV Bergasa

The site of the pathogenic events responsible for initiating the pruritus of cholestasis has been assumed to be the skin. This assumption cannot be excluded but is not supported by convincing data. Empirical therapies such as anion exchange resins and rifampicin often appear to be partially efficacious. Recent evidence suggests that altered neurotransmission in the brain may contribute to this form of pruritus. In particular, the hypothesis that increased central opioidergic tone is involved is supported by three observations: opiate agonists induce opioid receptor-mediated scratching activity of central origin, central opioidergic tone is increased in cholestasis and opiate antagonists reduce scratching activity in cholestatic patients. Apparent subjective ameliorations of pruritus following intravenous administration of ondansetron to cholestatic patients suggest that altered serotoninergic neurotransmission may also contribute to this form of pruritus.

Cholestasis | Endogenous opioids | Ondansetron | Opiate antagonists | Pruritus
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