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Complications of cholestasis

Lookup NU author(s): Dr Vinod Hegade, Professor David Jones


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© 2019Cholestasis (impairment of, or reduction in, bile flow) can both predispose to the development of chronic liver disease and result in its own specific symptoms. The severity of cholestatic symptoms (which themselves often impair quality of life) is typically independent of the severity of the underlying liver disease, the link with cholestasis therefore frequently being missed. The most characteristic symptoms of cholestasis are pruritus and fatigue, the former being the most responsive to treatment. After excluding surgically or endoscopically treatable biliary tree obstruction, the first-line treatment for cholestatic pruritus is colestyramine. Rifampicin and the oral opiate antagonist naltrexone are effective second-line treatments with a good evidence base. There is currently no licensed or recommended therapy for fatigue and the approach is largely supportive. Osteoporosis can complicate cholestatic liver disease, although the risk has previously been overstated. The highest additional cholestasis-associated risk is seen in male patients, in patients taking corticosteroids and in the most severely cholestatic patients. Patients should undergo formal bone mineral density screening, and bisphosphonate treatment is highly effective.

Publication metadata

Author(s): Hegade VS, Jones DE

Publication type: Review

Publication status: Published

Journal: Medicine

Year: 2019

Volume: 47

Issue: 12

Pages: 818-821

Print publication date: 01/12/2019

Acceptance date: 02/04/2018

ISSN (print): 1357-3039

ISSN (electronic): 1365-4357

Publisher: Elsevier Ltd


DOI: 10.1016/j.mpmed.2019.09.009