Published online Feb 7, 2015. doi: 10.3748/wjg.v21.i5.1404
Peer-review started: August 12, 2014
First decision: September 15, 2014
Revised: October 29, 2014
Accepted: November 19, 2014
Article in press: November 19, 2014
Published online: February 7, 2015
Processing time: 182 Days and 7.7 Hours
To review the underlying pathophysiology and currently available treatments for pruritis associated with jaundice. English language literature was reviewed using MEDLINE, PubMed, EMBASE and clinicaltrials.gov for papers and trails addressing the pathophysiology and potential treatments for pruritis associated with jaundice. Recent advances in the understanding of the peripheral anatomy of itch transmission have defined a histamine stimulated pathway and a cowhage stimulated pathway with sensation conveyed centrally via the contralateral spinothalamic tract. Centrally, cowhage and histamine stimulated neurons terminate widely within the thalamus and sensorimotor cortex. The causative factors for itch in jaundice have not been clarified although endogenous opioids, serotonin, steroid and lysophosphatidic acid all play a role. Current guidelines for the treatment of itching in jaundice recommend initial management with biliary drainage where possible and medical management with ursodeoxycholic acid, followed by cholestyramine, rifampicin, naltrexone and sertraline. Other than biliary drainage no single treatment has proved universally effective. Pruritis associated with jaundice is a common but poorly understood condition for which biliary drainage is the most effective therapy. Pharmacological therapy has advanced but remains variably effective.
Core tip: The occurrence of pruritis in association with jaundice has been recognized for many years but its pathogenesis is poorly understood. Recent advances in understanding the neural pathways involved in itch have contributed to the clinical treatment of this important symptom.