[Drug treatment of cholestatic liver diseases]

After a brief summary of the pathophysiology and natural history of different cholestatic disorders novel forms of treatment are considered. Treatment of different syndromes with ursodeoxycholic acid is considered in some depth. While the substance has clearly proven its efficacy in the symptomatic treatment, its influence on hard parameters such as survival and transplantation requirements remains to be documented. S-adenoylmethionine has shown to be efficaceous in some but not all studies on pruritus of pregnancy. The substance holds promise in other cholestatic disorders as well, but clearly more studies are needed before its therapeutic potential can be appreciated. Finally, nowadays orthotopic liver transplantation should be considered early in patients with progressive cholestatic liver disorders.