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rifampicine in cholestasis of pregnancy

C Guth, U Beuers, K Beckh
Intermittent cholestatic liver disease may indicate an inherited deficiency of bile salt transport proteins. Episodes of cholestasis may start during pregnancy or during use of oral contraceptives or other medication. We describe the case of a 22-year-old mother with increasing jaundice and severe pruritus two weeks after starting hormonal contraception. A few months before she was suffering from intrahepatic cholestasis of pregnancy (ICP). Liver biopsy showed bland cholestasis with canalicular bile plugs...
September 2016: Zeitschrift Für Gastroenterologie
Asit Mittal
Cholestatic itch is a feature of numerous hepatobiliary disorders such as primary biliary cirrhosis, primary sclerosing cholangitis, the inherited form of cholestasis, and intrahepatic cholestasis of pregnancy. Although undervalued by physicians, cholestatic itch can be a source of great discomfort to the patient and significantly affects quality of life. Many pruritogens such as bile salts, opioids, serotonin, and histamine have been implicated in the pathogenesis of cholestatic itch, but no causative link has ever been established...
2016: Current Problems in Dermatology
Andreas E Kremer, Barbara Namer, Ruth Bolier, Michael J Fischer, Ronald P Oude Elferink, Ulrich Beuers
Pruritus is a preeminent symptom in patients with chronic cholestatic liver disorders such as primary biliary cirrhosis and primary sclerosing cholangitis. More than two-thirds of these patients experience itching during the course of their disease. This symptom is also frequently observed in patients with other causes of cholestasis such as cholangiocarcinoma, inherited forms of cholestasis and intrahepatic cholestasis of pregnancy, but may accompany almost any other liver disease. The pathogenesis of pruritus of cholestasis remains largely elusive...
2015: Digestive Diseases
Victoria Geenes, Jenny Chambers, Rshmi Khurana, Elisabeth Wikstrom Shemer, Winnie Sia, Dalvinder Mandair, Elwyn Elias, Hanns-Ulrich Marschall, William Hague, Catherine Williamson
OBJECTIVE: To describe the use of combined ursodeoxycholic acid (UDCA) and rifampicin treatment in intrahepatic cholestasis of pregnancy (ICP). STUDY DESIGN: A questionnaire survey of 27 women with 28 affected pregnancies identified via the UK and International Obstetric Medicine forum. The clinical case notes of women with ICP treated with combined UDCA and rifampicin therapy were reviewed, and data regarding maternal and perinatal outcomes extracted. RESULTS: Serum bile acids remained high whilst taking UDCA as monotherapy...
June 2015: European Journal of Obstetrics, Gynecology, and Reproductive Biology
A Ruth Bolier, Jiska M Jebbink, Joris A M van der Post, Ronald P J Oude Elferink, Ulrich Beuers
Intrahepatic cholestasis of pregnancy (ICP) is defined as pruritus during pregnancy in the absence of primary skin lesions, combined with an increase in serum total bile salts and/or abnormal serum liver tests. This article provides an insight into the diagnostic and therapeutic considerations by presenting two cases. ICP usually presents around 34 weeks of gestation, but can be present early in pregnancy as described in a 32-year-old patient pregnant after in-vitro fertilization. DNA analysis showed a mutation in the ABCB4 gene, causing MDR3 deficiency...
2014: Nederlands Tijdschrift Voor Geneeskunde
Andreas E Kremer, Ruth Bolier, Remco van Dijk, Ronald P J Oude Elferink, Ulrich Beuers
Chronic pruritus is a burdensome feature of numerous hepatobiliary disorders such as primary biliary cirrhosis, primary sclerosing cholangitis, cholangiocarcinoma, inherited forms of cholestasis and intrahepatic cholestasis of pregnancy. Bile salts, μ-opioids, serotonin, histamine and steroids have been controversially discussed in the pathogenesis of cholestatic pruritus. However, for these substances neither a correlation with itch severity nor a causative link has ever been established. Recent findings indicate that the potent neuronal activator lysophosphatidic acid and autotaxin, the enzyme forming lysophosphatidic acid, may play a key element in the pathogenesis of cholestatic pruritus...
2014: Digestive Diseases
M Vidailhet, E Mallet, A Bocquet, J-L Bresson, A Briend, J-P Chouraqui, D Darmaun, C Dupont, M-L Frelut, J Ghisolfi, J-P Girardet, O Goulet, R Hankard, D Rieu, U Simeoni, D Turck
The aims of the present position paper by the Committee on Nutrition of the French Society of Paediatrics were to summarize the recently published data on vitamin D in infants, children and adolescents, i.e., on metabolism, physiological effects, and requirements and to make recommendations on supplementation after careful review of the evidence. Scientific evidence indicates that calcium and vitamin D play key roles in bone health. The current evidence, limited to observational studies, however, does not support other benefits for vitamin D...
March 2012: Archives de Pédiatrie: Organe Officiel de la Sociéte Française de Pédiatrie
Alvaro Terán, Emilio Fábrega, Fernando Pons-Romero
Pruritus is commonly associated with cholestatic disorders and shows wide interindividual variability. The presence of skin lesions due to scratching and the application of a visual analogue scale are useful for clinical evaluation. Although the pathophysiology of this entity is not well understood, advances have recently been made in understanding of the pruritoceptive neural pathway, which shares certain similarities with the nociceptive pathway, although there are other distinguishing characteristics such as the action of a specific neurotransmitter, GPR, on the first synapsis at the posterior horn of the spinal cord...
April 2010: Gastroenterología y Hepatología
B M Owen, S W C Van Mil, M Boudjelal, I McLay, W Cairns, E Elias, R White, C Williamson, P H Dixon
1. The purpose of this study was to evaluate the role of coding variation in hPXR (NR1I2) in intrahepatic cholestasis of pregnancy (ICP) and to functionally asses the response of PXR variants to ligands of interest in ICP. 2. The coding region of hPXR was sequenced in a cohort of 121 Caucasian ICP patients and exon 2 was sequenced in an additional 226 cases. Reporter assays were used to evaluate the function of all known hPXR variants in response to the secondary bile acid lithocholic acid and therapeutic agents rifampicin, ursodeoxycholic acid and dexamethasone...
October 2008: Xenobiotica; the Fate of Foreign Compounds in Biological Systems
Marta Vallejo, Oscar Briz, Maria A Serrano, Maria J Monte, Jose J G Marin
BACKGROUND/AIMS: Progesterone metabolites such as 5alpha-pregnan-3alpha-ol-20-one (PM4) are elevated in serum of women with intrahepatic cholestasis of pregnancy (ICP). METHODS/RESULTS: When assayed in isolated perfused rat liver, PM4 did not induce cholestasis, whereas sulfated PM4 (PM4-S), which unlike PM4 is secreted into bile, reduced bile flow and bile acid (BA) output. Whether PM4-S inhibited the bile salt export pump (BSEP) was investigated. Radiolabeled methylesters (ME) of cholic acid and chenodeoxycholic acid were taken up by Xenopus laevis oocytes co-expressing rat BSEP and human carboxylesterase-1 (CES1), efficiently hydrolyzed to free BAs by CES1 and subsequently exported by BSEP...
June 2006: Journal of Hepatology
H G Limbach, H J Jesberger, G Löffler
5 days after birth a premature baby of 1,300 g (31st week of gestation) was examined, because a congenital tuberculosis was suspected. In the stomach secretion mycobacterium tuberculosis could in fact be found. Abdominal symptoms as well as a post-natal anemia could be lead back to the infection. For three months a double parenteral therapy with INH (10 mg/kg/d) and Rifampicin (10 mg/kg/d) was carried through, then a mono therapy with INH for another 6 months. The bacillus had become resistant to streptomycin...
January 1993: Klinische Pädiatrie
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