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Pruritis

Dig Dis Sci 1997 May;42(5):1094-1099

Pruritis in chronic Hepatitis C: Association with high serum bile acids, advanced pathology, and bile duct abnormalities.

Lebovics E, Seif F, Kim D, Elhosseiny A, Dworkin BM, Casellas A, Clark S, Rosenthal WS

Pruritus is a common symptom of chronic cholestatic liver diseases but is considered rare in chronic hepatitis. We observed pruritus to be an unusually common complaint in patients with advanced chronic Hepatitis C. We reviewed the records of 175 chronic Hepatitis C patients to identify patients with severe, diffuse, unexplained pruritus; 12 consecutive prospective patients undergoing liver biopsy for chronic Hepatitis C served as controls. Assessment included laboratory biochemical tests and assessment of liver pathology by stage, grade, hepatic activity index, and a bile duct score. Pruritus was present in nine (5.1%) patients. Serum AST, ALT, alkaline phosphatase, GGTP, total bilirubin, and ferritin were similar in pruritics and controls. Pruritics had higher serum bile acids (2028.4 +/- 223.1 mmol/liter vs 423.1 +/- 194.3, P less than0.001), higher transferrin saturation (57.5 +/- 6.8% vs 33.2 +/- 3.3, P less than 0.01), and lower HCV RNA by bDNA (24.5 +/- 12.7 x 10(5) vs 172.7 +/- 54.1 x 10(5), P less than 0.05). Pathology revealed cirrhosis in 6/9 (66.6%) pruritics vs 1/12 (8.3%) controls (P less than0.01). Pruritics had higher pathologic stage (3.7 +/- 0.2 vs 2.2 +/- 0.4, P less than 0.01), grade (4.4 +/- 0.2 vs 2.1 +/- 0.2, P less than 0.001), activity index (14.3 +/- 1.9 vs 8.6 +/- 1.9, P less than 0.025), and bile duct score (7.6 +/- 0.6 vs 4.7 +/- 0.4, P less than 0.01). Of eight pruritics treated with IFN-alpha2b, two had complete ALT response and one relapsed. Pruritus followed a relapsing course and only three patients partially responded despite a variety of interventions. In conclusion, pruritus is a common complication of advanced CHC. Its presence is associated with high serum bile acids, advanced pathology and bile duct abnormalities. The clinical course of pruritus is relapsing and response to therapy is inconsistent. These features suggest that pruritus in CHC has a pathogenesis that may vary from that of chronic cholestatic diseases.

PMID: 9149069, UI: 97293016

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