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Cholestatic Pruritus PBC — RACP Adult Medicine MCQ

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EasyGastroenterologyCholestatic Pruritus PBCRACP Adult Medicine

A 55-year-old woman with primary biliary cholangitis on UDCA presents with severe generalised pruritus, worse in the evening and at night. She has jaundice (bilirubin 85 μmol/L) and elevated bile acids. Skin examination shows excoriations but no primary lesion. What is the most appropriate first-line treatment for her pruritus?

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Correct answer: A — Cholestatic pruritus

Cholestatic pruritus in PBC is caused by bile acid accumulation. It is the clinical diagnosis — among options, cholestatic pruritus is correct. First-line treatment: cholestyramine (bile acid sequestrant, 4 g before and after breakfast). Second-line: rifampicin (enzyme inducer, enhances bile acid metabolism — monitor LFTs). Third-line: naltrexone (opioid antagonist), sertraline, or experimental therapies (IBAT inhibitors).

Reference: EASL – 2022 – PBC Pruritus; eTG Gastrointestinal 2024