Complications of cholestasis : symptoms and extrahepatic manifestations

Abstract

Cholestasis is a state of impaired or reduced bile flow, resulting from intrahepatic disease, cholangiocellular disorders or large bile duct obstruction. Although disease-modifying treatments exist, not all provide the relief that patients seek. Pruritus and fatigue are the most commonly reported symptoms, and chronic cholestatic disorders can be complicated by hepatic osteodystrophy, dyslipidaemia and hypovitaminosis. Mechanistic insights into specific biological pathways have led to a revived interest in developing symptom-specific therapies, with a resurgence of clinical trial activity directed toward improving patients’ quality of life. However, with the exceptions of itch and metabolic bone disease, recommendations for managing the systemic complications of cholestasis currently lack an evidence base.