Cholestasis is a condition in which the flow of bile is impaired at some point between the liver cells and the small intestine. Bile is the digestive fluid that’s produced by the liver. When bile flow is stopped, the pigment bilirubin, a waste product that’s formed when old or damaged red blood cells are broken down, escapes into the bloodstream and accumulates.
Normally, bilirubin binds with bile in the liver and moves through the bile ducts into the digestive tract, where it’s eliminated in stool, but for people with cholestasis, substances that are normally excreted into bile are retained.
The two basic distinctions are an obstructive type of cholestasis where there is a mechanical blockage in the duct system that can occur from a gallstone or malignancy, and metabolic types of cholestasis which are disturbances in bile formation that can occur because of genetic defects or acquired as a side effect of many medications.
Itchiness (pruritus). Pruritus is the primary symptom of cholestasis and is thought to be due to interactions of serum bile acids with opioidergic nerves. In fact, the opioid antagonist naltrexone is used to treat pruritus due to cholestasis.
* Jaundice. Jaundice is an uncommon occurrence in intrahepatic (metabolic) cholestasis, but is common in obstructive cholestasis.
* Pale stool. This symptom implies obstructive cholestasis.
* Dark urine
* Birth control pills
* Antibiotics (such as TMP/SMX)
* Abdominal mass (e.g. cancer)
* Biliary atresia and other pediatric liver diseases
* Biliary trauma
* Congenital anomalies of the biliary tract
* Acute hepatitis
* Cystic fibrosis
* Intrahepatic cholestasis of pregnancy (obstetric cholestasis)
* Primary biliary cirrhosis, an autoimmune disorder
* Primary sclerosing cholangitis, associated with inflammatory bowel disease
* Some drugs (e.g. flucloxacillin and erythromycin)
Drugs such as gold salts, nitrofurantoin, anabolic steroids, chlorpromazine, prochlorperazine, sulindac, cimetidine, erythromycin, estrogen, and statins can cause cholestasis and may result in damage to the liver.
Cholestasis can be suspected when there is an elevation of both 5′-nucleotidase and ALP enzymes. With a few exceptions, the optimal test for cholestasis would be elevations of serum bile acid levels. However, this is not normally available in most clinical settings. The gamma-glutamyl transferase (GGT) enzyme was previously thought to be helpful in confirming a hepatic source of ALP; however, GGT elevations lack the necessary specificity to be a useful confirmatory test for ALP. Normally GGT and ALP are anchored to membranes of hepatocytes and are released in small amounts in hepatocellular damage. In cholestasis, synthesis of these enzymes is induced and they are made soluble. GGT is elevated because it leaks out from the bile duct cells due to pressure from inside bile ducts.
In a later stage of cholestasis AST, ALT and unconjugated bilirubin may be elevated due to hepatocyte damage as a secondary effect of cholestasis.
Under a microscope, the individual hepatocytes will have a brownish-green stippled appearance within the cytoplasm, representing bile that cannot get out of the cell. Canalicular bile plugs between individual hepatocytes or within bile ducts may also be seen, representing bile that has been excreted from the hepatocytes but cannot go any further due to the obstruction. When these plugs occur within the bile duct, sufficient pressure (caused by bile accumulation) can cause them to rupture, spilling bile into the surrounding tissue, causing hepatic necrosis. These areas are known as bile lakes, and are typically seen only with extra-hepatic obstruction.
Extrahepatic cholestasis can usually be treated by surgery. Pruritis in cholestatic jaundice is treated by antihistamines, ursodeoxycholic acid, and phenobarbital. Nalfurafine hydrochloride can also treat pruritus caused by chronic liver disease and was recently approved in Japan for this purpose.
Herbal & Natural Treatments for Cholestasis:
1. Guar Gum:
Guar gum is a fiber from the seed of the guar plant. It’s commonly used as a laxative, for reducing cholesterol and preventing diabetes and obesity. Guar gum works as a binding and stabilizing agent, which is why it may be useful in relieving symptoms of cholestasis.
A study published in the European Journal of Clinical Investigation investigated whether intestinal binding of bile by guar gum relieves cholestasis and pruritus in intrahepatic cholestasis of pregnancy (ICP. Forty-eight pregnant women with cholestasis and pruritus were given either guar gum or placebo until the time of delivery, and 20 healthy pregnant women were used as control subjects. Researchers found that the increase in serum bile acids and worsening of pruritus were prevented by guar gum in relation to placebo.
2. Activated Charcoal:
Studies show that activated charcoal may be considered an alternative therapy in the treatment of intrahepatic cholestasis of pregnancy. Activated charcoal is a potent natural treatment that’s used to trap toxins and chemicals in the body, allowing them to be flushed out before they’re absorbed. The porous surface of activated charcoal has a negative electric charge that causes positive charged toxins and gas to bond with it.
A 1994 study found that after eight days of treatment, activated charcoal (at 30 grams, three times per day) was able to lower total bile acid concentrations in patients with ICP.
3. Milk Thistle:
Milk thistle is a natural herb that’s commonly used to detoxify the body, especially the liver. It’s able to promote healthy digestive function by increasing bile production and decreasing inflammation. Several studies indicate that milk thistle is effective in a variety of liver diseases, including cholestasis. (3) It’s also safe to use during pregnancy and while breastfeeding.
4. Dandelion Root:
Dandelion root and dandelion tea are safe natural remedies for cholestasis of pregnancy and have been proven to strengthen and benefit the liver. Dandelion root is used for gallstones, and it increases urine production and serves as a natural laxative. Research shows that the vitamins and nutrients present in dandelions help cleanse the liver and keep them working properly. Dandelions aid the digestive system by maintaining the proper flow of bile, and they promote mineral absorption.
SAMe, or S-adenosyl-L-methionine, is a molecule that’s formed naturally in the body and is also made in the laboratory to help the body form, activate and break down chemicals in the body. A study published in Drugs involving 639 patients with cholestasis due to acute or chronic liver disease found that SAMe may act by promoting transsulfuration pathway reactions, which means that it helps metabolic pathways function properly and consequently improves the detoxifying capacity of the metabolic system.
Researchers report that SAMe appears to be the first safe and effective approach to the treatment of this syndrome, and it also protects against the adverse effects of small doses of estrogen in patients with a history of ICP.
6. Vitamin K:
Vitamin K can be taken to improve blood clotting, unless your liver is severely damaged. It’s a suggested course of treatment for mothers with ICP because it reduces the absorption of fat-soluble vitamins that can lead to a vitamin K deficiency. For women who are pregnant, a vitamin K deficiency can lead to serious complications for the mother and infant.
7. Vitamin D and Calcium:
Research shows that metabolic bone disease is common in patients with cholestatic liver disease. Researchers measured intestinal calcium absorption in relation to vitamin D status in 14 patients with chronic cholestatic liver disease, including 11 with primary biliary cirrhosis. They found that 57 percent of patients had a decreased calcium absorption compared to controls, and a significant correlation was observed between serum vitamin D levels and calcium absorption. Treatment with oral vitamin D3 helped correct low vitamin D levels, which thereby improved calcium absorption.
8. Avoid Alcohol and Certain Drugs:
People with cholestasis are advised to avoid or stop using any substance that’s toxic to the liver, including alcohol and certain drugs. According to research conducted at the University of Sydney in Australia, agents known for many years to cause cholestasis include estrogens and anabolic steroids, chlorpromazine, erythromycin, and oxypenicillins. Contemporary drugs linked to cholestastic liver injury include ticlopidine, terfenadine, terbinafine, nimesulide, irbesartan, fluoroquinolones and cholesterol-lowering statins. Offending drugs should be withdrawn immediately in order to treat drug-induced cholestasis.
While there is increasing evidence of a genetic predisposition to cholestatic drug reactions, there are currently no pretreatment tests to predict drug safety. Therefore, prevention of severe reactions relies on early detection of liver injury and prompt drug withdrawal.
Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.