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Complications of cholestasis

Lookup NU author(s): Professor David Jones


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Cholestasis (impairment of, or reduction in, bile flow) can both pre-dispose to the development of chronic liver disease and result in its own specific symptoms. The severity of cholestatic symptoms (which can often dramatically impinge on quality of life in their own right) is typically independent of the severity of the underlying liver disease, the link with cholestasis frequently being missed as a result. The most characteristic symptoms of cholestasis are pruritus and fatigue, the former being the most responsive to treatment. Following exclusion of surgically or endoscopically treatable biliary tree obstruction, the first-line treatment for cholestatic pruritus is cholestyramine. Rifampicin and the oral opiate antagonist naltrexone are extremely effective second-line treatments. The treatment of fatigue is currently more difficult. Selective serotonin re-uptake inhibitors and naltrexone have some efficacy and should be considered. Osteoporosis can complicate cholestatic liver, although the risk has in the past been overstated. The highest additional cholestasis-associated risk is seen in male patients, in patients receiving steroid treatment, and in most cholestatic patients. Bisphosphonate treatment is highly effective and patients should undergo formal screening. © 2006 Elsevier Ltd. All rights reserved.

Publication metadata

Author(s): Jones DEJ

Publication type: Article

Publication status: Published

Journal: Medicine

Year: 2007

Volume: 35

Issue: 2

Pages: 96-98

ISSN (print): 1357-3039

ISSN (electronic): 1365-4357

Publisher: Medicine Publishing Company


DOI: 10.1016/j.mpmed.2006.11.015


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