Related Experiment Videos
Current pharmacotherapy for cholestatic liver disease
Elizabeth J Carey1, Keith D Lindor
1Mayo Clinic in Arizona, Division of Hepatology, Phoenix, AZ 85054, USA. carey.elizabeth@mayo.edu
Expert Opinion on Pharmacotherapy
|October 26, 2012
Summary
Effective treatments for cholestatic liver diseases are limited. While ursodeoxycholic acid (UDCA) helps primary biliary cirrhosis, new therapies like farnesoid X receptor agonists show promise for these serious liver conditions.
Area of Science:
- Hepatology
- Gastroenterology
- Internal Medicine
Background:
- Cholestatic liver diseases are a diverse group of disorders that can lead to cirrhosis and liver failure if untreated.
- Early diagnosis of these conditions allows for timely intervention and disease-modifying therapies.
Purpose of the Study:
- To review the current pharmacologic management of common adult cholestatic liver diseases.
- To discuss the management of complications arising from cholestasis.
Main Methods:
- This review synthesizes current literature on pharmacologic treatments for specific cholestatic liver diseases.
- Includes primary biliary cirrhosis, autoimmune hepatitis overlap, primary sclerosing cholangitis, intrahepatic cholestasis of pregnancy, IFALD, and IgG4-associated cholangitis.
Main Results:
- Ursodeoxycholic acid (UDCA) offers partial benefit for primary biliary cirrhosis but does not cure it.
- No effective medical therapy currently exists for primary sclerosing cholangitis.
- Steroids are effective for IgG4-associated cholangitis but relapse can occur.
Conclusions:
- Effective pharmacologic therapies for many cholestatic liver diseases remain limited.
- Ursodeoxycholic acid (UDCA) shows some efficacy but does not fully resolve primary biliary cirrhosis or intrahepatic cholestasis of pregnancy.
- Farnesoid X receptor agonists represent a promising new therapeutic class under investigation for cholestatic liver diseases.
Related Concept Videos
01:20Lipid-Lowering Drugs: Statins and Miscellaneous Agents
Hyperlipidemia, a medical condition often referred to as high cholesterol, is characterized by abnormally elevated levels of lipids in the bloodstream. When present in excess, these lipids, specifically cholesterol and triglycerides, can lead to serious health complications, often involving cardiovascular diseases. Illnesses like atherosclerosis, heart attacks, and pancreatitis have all been linked to untreated hyperlipidemia. This means controlling and regulating cholesterol and triglyceride...
01:26Effect of Hepatic Disease on Pharmacokinetics: Drug Dosing and Hepatic Blood Flow
Chronic liver disease significantly impacts drug metabolism due to alterations in hepatic blood flow and enzyme accessibility. This disruption affects the body's pharmacokinetics—the movement and processing of drugs within the system. Key enzymes crucial for metabolizing medications become less accessible, changing how drugs are processed and utilized. Furthermore, liver disease influences the synthesis of plasma proteins, such as albumin and globulins, which play critical roles in drug binding...
01:17Hepatic Drug Excretion: Enterohepatic Cycling
Enterohepatic cycling involves the active secretion of drugs and their metabolites into the bile via transporters in the canalicular membrane of hepatocytes. This secretion is an integral part of the digestive process, releasing these substances into the gastrointestinal (GI) tract.
Post-release drugs and metabolites can be reabsorbed into the body from the intestine. For conjugated metabolites like glucuronides, reabsorption requires enzymatic hydrolysis by intestinal microflora. This...
Post-release drugs and metabolites can be reabsorbed into the body from the intestine. For conjugated metabolites like glucuronides, reabsorption requires enzymatic hydrolysis by intestinal microflora. This...
01:22Effect of Hepatic Disease on Pharmacokinetics: Pathophysiologic Assessment and Liver Function Test
In clinical practice, the direct measurement of hepatic blood flow to evaluate liver function presents significant challenges due to the intricate and specialized nature of the necessary techniques. Consequently, healthcare professionals often rely on empirical estimates derived from thorough patient examinations and liver function tests to gauge liver health. Among the tools at their disposal, the Child–Pugh and MELD scoring systems stand out for their ability to categorize and assess the...
01:16Hepatic Drug Excretion: Influencing Factors
The biliary system of the liver, crucial for bile secretion and drug excretion, comprises intrahepatic bile ducts that merge to form the common hepatic duct. This duct, carrying hepatic bile, combines with the cystic duct, draining the gallbladder and forming the common bile duct, which empties into the duodenum. Bile, produced by hepatic cells lining the bile canaliculi, is composed primarily of water, bile salts, pigments, electrolytes, and lesser amounts of cholesterol and fatty acids. Bile...
01:29Inflammatory Bowel Disease IV: Pharmacological Management
Upon diagnosis, managing Inflammatory Bowel Disease (IBD) involves addressing several crucial aspects. The primary goals include resting the bowel, correcting malnutrition, and providing symptomatic relief. Resting the bowel may consist of medications to reduce inflammation and promote healing. Correcting malnutrition is essential, often requiring dietary adjustments and nutritional supplements. Symptomatic relief aims to ease pain, diarrhea, and other discomforts in IBD.
Pharmacologic...
Pharmacologic...