Bile Salts and Pruritus

Despite some conflicting observations (55), the bulk of recent evidence supports the hypothesis that increased concentrations of bile salts in the skin, resulting from sustained elevations in serum concentrations, are the responsible circumstance for pruritic jaundice. Higher concentrations of bile salts occur in the skin of patients who itch than in those who do not (56). A reduction in high skin bile salt concentrations in a jaundiced patient with pancreatic carcinoma followed cholecystojejunostomy, and this was accompanied 

A nonabsorbable strongly basic anion exchange resin which binds bile salts in the intestinal lumen, thereby removing them from the enterohepatic circulation for excretion in the feces, will relieve pruritus in patients who do not have complete biliary obstruction. When serum bile salt concentrations are measured serially at frequent intervals during cholestyramine feeding, it can be shown that concentrations reach near normal levels before pruritus stops, and when cholestyramine is withheld, high serum concentrations are reached before pruritus starts. This lag period, which may be a day or more, may represent the period of time required for concentrations of bile salts sufficient to induce pruritus to accumulate in or leave the skin (57). 

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