Pruritus is a common and potentially severe complication of primary sclerosing cholangitis (PSC). When imaging and evaluation do not identify a dominant or relevant biliary stricture or biliary obstruction, a specific structured protocol guides management of this symptom.
Patient with primary sclerosing cholangitis presenting with pruritus (skin itching) in the absence of a dominant or relevant biliary stricture or biliary obstruction. Between 30% and 60% of patients with PSC experience pruritus, which can become severe and disabling.
This protocol addresses refractory pruritus in PSC, with the pathway culminating in consideration of a major surgical intervention for patients with intractable symptoms.
Many patients with PSC (30%–60%) suffer from pruritus, or itch, which can be severe and disabling.
In the absence of a relevant stricture, a stepwise therapeutic approach should be followed starting with heat avoidance, emollients, and/or antihistamines, followed if necessary by first-line (cholestyramine), second-line (sertraline, rifampin, and/or naltrexone), and third-line (phenobarbital, plasmapheresis, and/or phototherapy) therapy, with LT considered for continued refractory symptoms.
LT should be considered in all patients with PSC and complications of end-stage liver disease, recurrent cholangitis, intractable pruritus, or early-stage hepatobiliary cancers.
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