Resumen de Complications of cholestasis
Vinod S. Hegade, David E.J. Jones
Cholestasis (impairment of, or reduction in, bile flow) can both predispose to the development of chronic liver disease and result in its own specific symptoms. The severity of cholestatic symptoms (which themselves can often impair quality of life) is typically independent of the severity of the underlying liver disease, the link with cholestasis frequently being missed as a result. The most characteristic symptoms of cholestasis are pruritus and fatigue, the former being the most responsive to treatment. Following exclusion of surgically or endoscopically treatable biliary tree obstruction, the first-line treatment for cholestatic pruritus is colestyramine. Rifampicin and the oral opiate antagonist, naltrexone, are extremely effective second-line treatments. Currently there is no recommended therapy for fatigue. Osteoporosis can complicate cholestatic liver disease, although the risk has in the past been overstated. The highest additional cholestasis-associated risk is seen in male patients, in patients taking corticosteroid treatment and in the most severely cholestatic patients. Patients should undergo formal bone mineral density screening and bisphosphonate treatment is highly effective.
