The Treatment of Pruritus and Hypercholesteremia of Primary Biliary Cirrhosis with Cholestyramine

Itallie, Theodore B. Van; Hashim, Sami A.; Crampton, Roslyn; Tennent, David M.

doi:10.1056/nejm196109072651004

Cited by 106 publications

(31 citation statements)

References 15 publications

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“…However, since they studied only one of the several bile acids excreted in man, an over-all estimation of the effect of the resin on cholesterol catabolism could not be made from their study. This resin has been used to relieve the pruritis associated with jaundice and incomplete biliary obstruction in man (13,38,39), and a lowering of blood bile acid concentrations with relief of pruritis has been demonstrated in such patients (13). Tennent, Siegel, Zanetti, Kuron, Ott, and Wolf (1) reported an increase in both the bile acid (2.6-fold) and the sterol (1.8-fold) output in a dog given very large doses of cholestyramine (25 g/day).…”

Section: Discussionmentioning

confidence: 99%

Effect of cholestyramine on the fecal excretion of intravenously administered cholesterol-4-14C and its degradation products in a hypercholesterolemic patient

Moore¹,

Crane²,

Frantz³

1968

J. Clin. Invest.

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Section: Discussionmentioning

confidence: 99%

Effect of cholestyramine on the fecal excretion of intravenously administered cholesterol-4-14C and its degradation products in a hypercholesterolemic patient

Moore¹,

Crane²,

Frantz³

1968

J. Clin. Invest.

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“…Beneficial effects for cholestyramine have been reported in several small uncontrolled case series [77,78,79,80,81,82,83,84]. Cholestyramine is recommended as a 4-gram sachet 1 h before and after breakfast and may be extended to 16 g/day.…”

Section: Managementmentioning

confidence: 99%

Advances in Pathogenesis and Management of Pruritus in Cholestasis

Kremer

Bolier

Dijk

et al. 2014

Dig Dis

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Chronic pruritus is a burdensome feature of numerous hepatobiliary disorders such as primary biliary cirrhosis, primary sclerosing cholangitis, cholangiocarcinoma, inherited forms of cholestasis and intrahepatic cholestasis of pregnancy. Bile salts, μ-opioids, serotonin, histamine and steroids have been controversially discussed in the pathogenesis of cholestatic pruritus. However, for these substances neither a correlation with itch severity nor a causative link has ever been established. Recent findings indicate that the potent neuronal activator lysophosphatidic acid and autotaxin, the enzyme forming lysophosphatidic acid, may play a key element in the pathogenesis of cholestatic pruritus. Serum activity of autotaxin correlated with itch intensity and response to antipruritic treatment in patients with cholestatic pruritus, but not other forms of pruritus. Autotaxin activity thereby represents the first biomarker for pruritus and had a positive predictive value of 70% in differentiating cholestatic pruritus from other forms of pruritus. Treatment options for patients with cholestatic pruritus include the anion exchange resin colestyramine, the PXR agonist rifampicin, the μ-opioid antagonist naltrexone, and the serotonin reuptake inhibitor sertraline. These drugs are recommended by evidence-based guidelines as a stepwise therapeutic approach. Patients unresponsive to these drugs should be referred to specialized centers to receive experimental approaches such as UVB phototherapy, albumin dialysis, plasmapheresis or nasobiliary drainage. This review discusses pruritogen candidates in cholestasis, gives novel insights into the neuronal signaling pathway of pruritus and summarizes evidence-based treatment options for patients suffering from pruritus in cholestasis.

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“…(max. 16 g/d) is also used in the treatment of cholestatic pruritus with considerable success (Van Itallie et al, 1961).…”

Section: Therapeutical Optionsmentioning

confidence: 99%

Ciguatera fish poisoning: A first epidemic in Germany highlights an increasing risk for European countries

Mattei¹,

Vetter²,

Eisenblätter³

et al. 2014

Toxicon

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a b s t r a c tToxin-producing microalgae are thriving worldwide due to coral reef destruction and global warming with major consequences on ecosystems, international trade and human health. Microalgae belonging to the family of flagellate protists, in particular dinoflagellates, secrete a variety of high-molecular-weight polyether toxins that accumulate through the marine food chain to cause disease in humans by acting as sodium channel activator toxins; ciguatera is the most frequent seafood-borne illness worldwide with 50,000 to 500,000 global incidences per annum and is usually limited to endemic areas located between 35 northern and 35 southern latitude. The rising global incidence frequency renders it a major human health problem, because no curative treatment is available yet and reliable detection assays are lacking. During the last decade ciguatera has increasingly become endemic in previously unaffected areas for two reasons: first global warming has contributed to the emergence of dinoflagellate species in subtropical and even temperate regions that previously had been constrained to tropical areas and second: in Europe globalization of fishing industry and tourism has led to a progressive increase in the number of ciguatera cases and a lack of awareness among medical personnel contributes to under-reporting. We review, through a recent ciguatera outbreak in Germany, the risk for ciguatera poisoning in Europe and highlight characteristic symptoms, current knowledge about disease pathomechanisms and treatment options.

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The Treatment of Pruritus and Hypercholesteremia of Primary Biliary Cirrhosis with Cholestyramine

Cited by 106 publications

References 15 publications

Effect of cholestyramine on the fecal excretion of intravenously administered cholesterol-4-14C and its degradation products in a hypercholesterolemic patient

Effect of cholestyramine on the fecal excretion of intravenously administered cholesterol-4-14C and its degradation products in a hypercholesterolemic patient

Advances in Pathogenesis and Management of Pruritus in Cholestasis

Ciguatera fish poisoning: A first epidemic in Germany highlights an increasing risk for European countries

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