Cholestasis: Causes, Symptoms, and Treatment

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Cholestasis: Causes, Symptoms, and Treatment

Question:

What is cholestasis? What are the causes, symptoms and treatment?

Answer:

Cholestasis refers to the backing up of bile. Bile is normally excreted from the liver into the duodenum (the first part of the small intestine). Here is help digest food. There are many causes of this bile back up, including:

• Blockage of the main bile duct by a gallstone or, less commonly, a tumor.

• Inflammatory disease within the bile ducts (primary sclerosing cholangitis and primary biliary cirrhosis).

• Damage to the tiniest ducts within the liver, most often as a result of a drug reaction or herbal therapy.

• Pregnancy in women who are genetically sensitive to the accompanying hormonal elevations.

• A variety of rare inherited disorders that interfere with bile secretion. These disorders are usually diagnosed during childhood.

The principal symptoms of cholestasis are jaundice (yellow discoloration of the skin and eyes), darkening of the urine and itching, which is often severe. Jaundice and dark urine are caused by the accumulation of bilirubin, the yellow pigment formed when hemoglobin breaks down. Bilirubin is normally excreted through the biliary system. Light-colored stools and decreased intestinal absorption of fat also may occur with cholestasis.

The treatment of cholestasis depends on its cause. Surgery or an endoscopic procedure is usually required to relieve cholestasis due to an obstructed bile duct. Cholestasis that is not treatable with surgical or endoscopic correction is often treated with the drug ursodiol. This loosens up the flow of bile. Cholestasis due to a drug reaction usually clears up on its own once the drug is stopped, though it may take a while to go away. The so-called "cholestasis of pregnancy" goes away soon after delivery. Ursodiol is sometimes prescribed for more severe cholestasis.

To treat intense itching, your doctor may prescribe cholestyramine or similar resins. The antibiotic rifampin is also helpful in relieving itching.

Stephen Goldfinger, M.D., is a professor of medicine at Harvard Medical School. He is a graduate of Columbia College of Physicians and Surgeons, and his clinical base is at the Massachusetts General Hospital.

Last updated:	July 20, 2009