GASTROENTEROLOGY ARTICLE OF THE WEEK

MARCH 9, 2000

 Jones EA, Bergasa NV. The pruritus of cholestasis.  Hepatology 1999;29:1003-1006

 1.  Regarding the treatment of pruritus of cholestasis

a.      cholestyramine is presumed to work by binding  putative puritogens  in the gut and inhibiting their absorption

b.      rifampin and Phenobarbital may be effective in treating pruritus of cholestasis by decreasing skin levels of bile acids and other puritogens

c.      ursodeoxycholic acid may be effective by improving intra-hepatic cholestasis

d.      antihistamines are efficacious on the treatment of pruritus of cholestasis

2.  Regarding the pathogenesis of pruritus of cholestasis

a.      it is evident that the primary event leading to pruritus occurs at the skin level, with the accumulation of pruritogenic substances

b.      the opioidergic tone is increased in patients with cholestasis, leading to a withdrawal-type syndrome when opiate-antagonists such as naloxone is administered.

c.      Plasma from patients with PBC induces pruritus in experimental animals if it is injected in the CNS.

d.      The serotonin system may also contribute to the pathogenic mechanisms of pruritus in cholestasis 

True or False

 3.  Opioid antagonists such as naltrexone or nalmefene have been found to be of value in the treatment of cholestasis.

 4.  The severity of the pruritus correlates with the severity of the cholestasis.

 5.  Pruritus of cholestasis is mediated by the accumulation of bile acids in the skin.

 6.  Medications that have been found to be effective in some cases of cholestasis induced pruritus include:

a.      Naltrexone

b.      Antihistamines

c.      Phenobarbital

d.      Ondansetron

e.      Cholestyramine

f.        Rifampin

g.      Benzodiazepines

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