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Canadian Journal of Gastroenterology
Volume 14, Issue 1, Pages 33-39
http://dx.doi.org/10.1155/2000/747495
Mini-Review

Evolving Concepts of the Pathogenesis and Treatment of the Pruritus of Cholestasis

E Anthony Jones1 and Nora V Bergasa2

1Department of Gastrointestinal and Liver Diseases, Academic Medical Center, Amsterdam, Netherlands
2Division of Gastroenterology and Liver Disease, Beth Israel Medical Center, New York, New York, USA

Received 28 May 1999; Revised 4 June 1999

Copyright © 2000 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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.