ABSTRACT
The intensity of pruritus in patients with liver disease does not seem to correlate with biochemical indices of liver disease or cholestasis. When pruritus complicates cholestatic diseases, such as PBC, the serum alkaline phosphatase level is typically elevated, but serum bilirubin mayor may not be increased. Noncholestatic liver diseases, which may be complicated by pruritus, include, notably, chronic hepatitis C and, also rarely, chronic hepatitis B and chronic alcoholic liver disease; in patients with these diseases, plasma indices of cholestasis (e.g., elevated serum alkaline phosphatase level) may be normal, but increased serum activity of transaminases is usually present. In cholestatic and chronic noncholestatic parenchymal liver diseases, elevated fasting serum total bile acid concentrations are usually present; an increase in fasting serum total bile acid concentrations is a sensitive index of cholestasis.
