Extrahepatic manifestations of cholestasis

[Guest guest]

Journal of Gastroenterology and Hepatology

Volume 17 Issue 9 Page 938 - September 2002

REVIEW

Extrahepatic manifestations of cholestasis

Helena Glasova and Ulrich Beuers

AbstractPruritus, fatigue and metabolic bone disease represent three

major extrahepatic manifestations of chronic cholestatic liver disease that

considerably affect the patient " s quality of life. The present article

reviews pathogenetic aspects of and current therapeutic approaches to

extrahepatic manifestations of cholestatic liver disease. Pathogenesis of

pruritus of cholestasis remains poorly understood. The involvement of

putative peripherally acting pruritogens, such as bile acids or endogenous

opioids, is being discussed. More recently, central mechanisms, including an

increased central opioidergic tone and pertubations in the serotonergic

system have been proposed. Treatment of the underlying disease is beneficial

also for the control of cholestasis-associated pruritus. Current therapeutic

recommendations include ursodeoxycholic acid, cholestyramine, rifampicin and

opioid antagonists. Liver transplantation may be indicated when severe

pruritus is refractory to medical treatment. Fatigue is being recognized as

the most frequent and one of the most disabling complaints in chronic

cholestasis. Fatigue is presumably of central origin and its association

with other neuropsychiatric disorders (e.g. depression,

obsessive -compulsive disorders) is consistent with defective central

neurotransmission. No specific therapies are currently available and a

healthy lifestyle, regular sleep and avoidance of unnecessary stress and

other precipiting factors are recommended. Antidepressant therapy may be

warranted in selected patients. Osteopenia and osteoporosis are common in

chronic cholestatic liver disease, whereas osteomalacia is rare. The

pathophysiology of cholestasis-associated metabolic bone disease is regarded

as multifactorial. Therapeutic recommendations include regular exercise,

calcium and vitamin D supplementation in late stage disease, hormone

replacement therapy in postmenopausal women and bisphosphonates.

© 2002 Blackwell Publishing Asia Pty Ltd

[Guest guest]

Journal of Gastroenterology and Hepatology

Volume 17 Issue 9 Page 938 - September 2002

REVIEW

Extrahepatic manifestations of cholestasis

Helena Glasova and Ulrich Beuers

AbstractPruritus, fatigue and metabolic bone disease represent three

major extrahepatic manifestations of chronic cholestatic liver disease that

considerably affect the patient " s quality of life. The present article

reviews pathogenetic aspects of and current therapeutic approaches to

extrahepatic manifestations of cholestatic liver disease. Pathogenesis of

pruritus of cholestasis remains poorly understood. The involvement of

putative peripherally acting pruritogens, such as bile acids or endogenous

opioids, is being discussed. More recently, central mechanisms, including an

increased central opioidergic tone and pertubations in the serotonergic

system have been proposed. Treatment of the underlying disease is beneficial

also for the control of cholestasis-associated pruritus. Current therapeutic

recommendations include ursodeoxycholic acid, cholestyramine, rifampicin and

opioid antagonists. Liver transplantation may be indicated when severe

pruritus is refractory to medical treatment. Fatigue is being recognized as

the most frequent and one of the most disabling complaints in chronic

cholestasis. Fatigue is presumably of central origin and its association

with other neuropsychiatric disorders (e.g. depression,

obsessive -compulsive disorders) is consistent with defective central

neurotransmission. No specific therapies are currently available and a

healthy lifestyle, regular sleep and avoidance of unnecessary stress and

other precipiting factors are recommended. Antidepressant therapy may be

warranted in selected patients. Osteopenia and osteoporosis are common in

chronic cholestatic liver disease, whereas osteomalacia is rare. The

pathophysiology of cholestasis-associated metabolic bone disease is regarded

as multifactorial. Therapeutic recommendations include regular exercise,

calcium and vitamin D supplementation in late stage disease, hormone

replacement therapy in postmenopausal women and bisphosphonates.

© 2002 Blackwell Publishing Asia Pty Ltd

[Guest guest]

Journal of Gastroenterology and Hepatology

Volume 17 Issue 9 Page 938 - September 2002

REVIEW

Extrahepatic manifestations of cholestasis

Helena Glasova and Ulrich Beuers

AbstractPruritus, fatigue and metabolic bone disease represent three

major extrahepatic manifestations of chronic cholestatic liver disease that

considerably affect the patient " s quality of life. The present article

reviews pathogenetic aspects of and current therapeutic approaches to

extrahepatic manifestations of cholestatic liver disease. Pathogenesis of

pruritus of cholestasis remains poorly understood. The involvement of

putative peripherally acting pruritogens, such as bile acids or endogenous

opioids, is being discussed. More recently, central mechanisms, including an

increased central opioidergic tone and pertubations in the serotonergic

system have been proposed. Treatment of the underlying disease is beneficial

also for the control of cholestasis-associated pruritus. Current therapeutic

recommendations include ursodeoxycholic acid, cholestyramine, rifampicin and

opioid antagonists. Liver transplantation may be indicated when severe

pruritus is refractory to medical treatment. Fatigue is being recognized as

the most frequent and one of the most disabling complaints in chronic

cholestasis. Fatigue is presumably of central origin and its association

with other neuropsychiatric disorders (e.g. depression,

obsessive -compulsive disorders) is consistent with defective central

neurotransmission. No specific therapies are currently available and a

healthy lifestyle, regular sleep and avoidance of unnecessary stress and

other precipiting factors are recommended. Antidepressant therapy may be

warranted in selected patients. Osteopenia and osteoporosis are common in

chronic cholestatic liver disease, whereas osteomalacia is rare. The

pathophysiology of cholestasis-associated metabolic bone disease is regarded

as multifactorial. Therapeutic recommendations include regular exercise,

calcium and vitamin D supplementation in late stage disease, hormone

replacement therapy in postmenopausal women and bisphosphonates.

© 2002 Blackwell Publishing Asia Pty Ltd

[Guest guest]

Journal of Gastroenterology and Hepatology

Volume 17 Issue 9 Page 938 - September 2002

REVIEW

Extrahepatic manifestations of cholestasis

Helena Glasova and Ulrich Beuers

AbstractPruritus, fatigue and metabolic bone disease represent three

major extrahepatic manifestations of chronic cholestatic liver disease that

considerably affect the patient " s quality of life. The present article

reviews pathogenetic aspects of and current therapeutic approaches to

extrahepatic manifestations of cholestatic liver disease. Pathogenesis of

pruritus of cholestasis remains poorly understood. The involvement of

putative peripherally acting pruritogens, such as bile acids or endogenous

opioids, is being discussed. More recently, central mechanisms, including an

increased central opioidergic tone and pertubations in the serotonergic

system have been proposed. Treatment of the underlying disease is beneficial

also for the control of cholestasis-associated pruritus. Current therapeutic

recommendations include ursodeoxycholic acid, cholestyramine, rifampicin and

opioid antagonists. Liver transplantation may be indicated when severe

pruritus is refractory to medical treatment. Fatigue is being recognized as

the most frequent and one of the most disabling complaints in chronic

cholestasis. Fatigue is presumably of central origin and its association

with other neuropsychiatric disorders (e.g. depression,

obsessive -compulsive disorders) is consistent with defective central

neurotransmission. No specific therapies are currently available and a

healthy lifestyle, regular sleep and avoidance of unnecessary stress and

other precipiting factors are recommended. Antidepressant therapy may be

warranted in selected patients. Osteopenia and osteoporosis are common in

chronic cholestatic liver disease, whereas osteomalacia is rare. The

pathophysiology of cholestasis-associated metabolic bone disease is regarded

as multifactorial. Therapeutic recommendations include regular exercise,

calcium and vitamin D supplementation in late stage disease, hormone

replacement therapy in postmenopausal women and bisphosphonates.

© 2002 Blackwell Publishing Asia Pty Ltd