Sun Sentinel Palm Beach Edition

Primary biliary cholangiti­s of the liver brings on severe itching

- Dr. Keith Roach Submit letters to ToYour or to 628 Virginia Drive, Orlando, FL 32803.

Dear Dr. Roach: Iaman 85-year-old female who has had primary biliary cirrhosis of the liver for many years. I have been on 300 mg of ursodiol taken three times a day for all those years, with no problems until now. I currently have severe itching all over my body. I am now taking 4 g of cholestyra­mine a day to relieve this terrible itching, but after two weeks, I am not feeling any relief. Will this medication work? If so, how long before it does? — B.N.

Dear B.N.: Primary biliary cholangiti­s (many still refer to it by its former name, primary biliary cirrhosis, even though many people never get cirrhosis) is an autoimmune disease, where the body attacks the bile ducts, leading to cholestasi­s (the lack of movement of bile).

It is a rare disease, much more common in women and usually diagnosed in middle age. It can be found by screening labs or with symptoms of fatigue, jaundice or itching.

Ursodeoxyc­holine (Ursodiol), first identified in bears, has been the mainstay of treatment with PBC and has improved the prognosis of this condition. It is used to slow progressio­n of the disease and prevent the need for liver transplant­ation by preventing cirrhosis.

Ursodeoxyc­holine by itself may not treat itching particular­ly well, and nearly 80% of people with PBC will develop itching by 10 years of having the condition. Most people do well with the cholestyra­mine you were given, although the dose necessary is sometimes a lot higher.

The dose is usually increased over weeks, so when you go back to your liver specialist, they may increase the dose. Be sure not to take ursodeoxyc­holine near the time you take the cholestyra­mine.

There are other options, including rifampin and naltrexone, if the cholestyra­mine does not work for you. Also, the itching in PBC sometimes comes and goes for no apparent reason.

Dear Dr. Roach: I’m curious about the effect of tart cherry juice on gout that you mentioned in a recent column. Any idea why? What’s unique in tart cherry juice? Does non-tart cherry juice work? What about tart strawberry or apple juice? — A.M.

Dear A.M.: There are several varieties of cherries, with most people being familiar with Bing and Rainier cherries. Tart (Montmorenc­y) cherries have been touted as having many health benefits, but regular cherries show a reduction in gout attacks. In the study, 10-12 cherries twice daily reduced gout attacks by 35%. (People with diabetes might not be appropriat­e for as much fruit intake.) Unfortunat­ely, alcohol and meals prone to cause gout flareups (such as shellfish) make the cherry intake less effective.

A separate trial on tart cherry juice did not find a benefit in reducing gout risk. Gout is caused by deposition of uric acid crystals, and most medication­s to reduce gout attacks focus on reducing uric acid in the blood.

But there seems to be something specific in cherries — a class of compounds called anthocyani­ns (found in cherries in high levels) are known to have anti-inflammato­ry effects. Other fruits, specifical­ly strawberri­es, grapes and kiwi, were tested and did not have the beneficial effects on the blood uric acid level that cherries did.

Cherries are not as effective as prescripti­on medication, such as allopurino­l, but may be helpful in people with very mild disease or who aren’t controlled with allopurino­l.

 ?? ??

Newspapers in English

Newspapers from United States