Itching in Liver Disease

Itching in Liver Disease

By Nora V. Bergasa, M. D.

Itching secondary to liver diseases, including primary biliary cirrhosis, primary sclerosing cholangitis, and hepatitis C, is a very difficult symptom for patients to endure and for physicians to manage. The reason why patients with liver disease itch is not known. It has been thought that some substances accumulate in the blood as a result of liver disease, causing itch.

Although the nature of the substance(s) that cause itch in liver disease is not known, evidence has been accumulating over the past several years to suggest that some substances that are found normally in plasma known as endogenous opioids (e.g. enkephalins), contribute, at least in part to the itch secondary to liver disease. It has been proposed that these neurotransmitters cause itch by acting on special areas of the brain. Other substances that also accumulate in the blood in liver disease, including bile acids, may also play a role in this type of itch. There is no strong evidence, however, to support that bile acids cause this type of itch.

Traditionally, the way itch has been studied has been by measuring the concentration of substances known to accumulate in the blood of patients with liver disease who itch. This method, however, has not advanced the understanding of what causes this type of itch.

In order to conduct scientific investigation, investigators have to apply reliable methods that allow for the collection of information that can be analyzed and interpreted in an objective way. The need for the availability of good methods has been recognized for many years by investigators in the field of itch. In this spirit, an instrument was designed over ten years ago that allows for the measurement of the human behavior that results from feeling the sensation of itch: scratching. Several clinical trials that use this method to record scratching have been conducted. These studies have provided some insight into itching and scratching, including the demonstration that some patients scratch with a 24-hour rhythm, known as circadian rhythm. This finding has suggested further that the itch secondary to liver disease is mediated in the brain.

At present there are several medications that are used for the treatment of itch in liver disease. These medications include cholestyramine, the antibiotic rifampicin, the opiate antagonists naloxone and naltrexone, and the serotonin type-3 receptor antagonist. These medications appear to decrease itching in many patients, but there is no medication that works well for all the patients. This reality underscores the need to continue to look for other medications that may relief the itch secondary to liver disease.

Other Information on Itching in Liver Diseases

Investigators from the Division of Digestive and Liver Diseases at Columbia University are conducting clinical studies in patients with itch. These studies involve full evaluations by investigators dedicated to the study of itch, and the exploration of scratching behavior. This comprehensive approach is expected to yield important information about what causes and what regulation the itch sensation. Click here for information on these trials, including those recruting patients with liver disease and itching.
Program of Itch Studies in Liver Diseases at Columbia University.

Diseases of the Liver Home Page