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Pruritus of unknown origin and elevated total serum bile acid levels in patients without clinically apparent liver disease.
MedLine Citation:
PMID:  21155876     Owner:  NLM     Status:  Publisher    
BACKGROUND: Generalized pruritus of unknown origin (PUO) is a highly distressing condition that is unrelated to any underlying dermatologic or systemic disorder (e.g. cholestasis). Little is known about the potential contribution of elevated total serum bile acid (TSBA) levels to PUO. AIMS: To investigate the role of elevated TSBA levels in patients with PUO and the efficacy of ursodeoxycholic acid (UDCA) and cholestyramine therapy. METHODS: Retrospective study comprising 117 patients with chronic pruritic conditions (PUO, atopic disease, asteatotic eczema, latent cholestasis, etc.); 99 patients with available TSBA levels were included and compared to healthy controls. RESULTS: Elevated TSBA levels were detected more frequently in patients with chronic pruritic diseases than in the control population (28.28% vs. 6%; p < 0.001) with significantly higher pathological absolute levels (mean 17.45 ± 34.46 µmol/l vs. 6.02 ± 4.73 µmol/l; p = 0.001). Patients with PUO (n = 18) showed the second-highest prevalence of pathological bile acid level elevation (83.3%; control population 6%; p < 0.001), after patients with subclinical cholestasis and presented with particularly high TSBA serum values (mean 37.79 ± 53.38 µmol/l; p < 0.001). Cholestyramine (n = 9) and UDCA (n = 8) therapy were both effective in lowering TSBA levels and lead to substantial improvement of pruritus in patients with elevated TSBA levels. CONCLUSION: TSBA levels are elevated in a high proportion of patients with PUO. These results provide evidence of a potential involvement of subclinical cholestasis in the pathogenesis of PUO. We suggest that evaluation of TSBA levels should be included in the diagnostic work-up of patients with chronic unexplained pruritus.
Klaus Eisendle; Hansgeorg Müller; Eveline Ortner; Heribert Talasz; Ivo Graziadei; Wofgang Vogel; Reinhard Höpfl
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2010-10-18
Journal Detail:
Title:  Journal of gastroenterology and hepatology     Volume:  -     ISSN:  1440-1746     ISO Abbreviation:  -     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-12-15     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8607909     Medline TA:  J Gastroenterol Hepatol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2010 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd.
Department of Dermatology & Venerology, Division of Clinical Biochemistry, Biocenter and Department of Gastroenterology and Hepatology, Medical University Innsbruck, Anichstrasse 35, 6020 Innsbruck, Austria.
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