Liu C, Elangovan A, Diaz DJ, Petrova L, Yekula A, Twohig P. Scratching the surface: A systematic review of modern approaches to diagnosing and treating cholestatic pruritus. World J Meta-Anal 2026; 14(3): 120937 [DOI: 10.13105/wjma.120937]
Corresponding Author of This Article
Patrick Twohig, MD, Assistant Professor, FRCPC, Department of Gastroenterology and Hepatology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, United States. patrick_twohig@urmc.rochester.edu
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
research-article
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
Share the Article
Liu C, Elangovan A, Diaz DJ, Petrova L, Yekula A, Twohig P. Scratching the surface: A systematic review of modern approaches to diagnosing and treating cholestatic pruritus. World J Meta-Anal 2026; 14(3): 120937 [DOI: 10.13105/wjma.120937]
World J Meta-Anal. Sep 18, 2026; 14(3): 120937 Published online Sep 18, 2026. doi: 10.13105/wjma.120937
Scratching the surface: A systematic review of modern approaches to diagnosing and treating cholestatic pruritus
Catherine Liu, Ashwath Elangovan, David Jerez Diaz, Lana Petrova, Anuroop Yekula, Patrick Twohig
Catherine Liu, Ashwath Elangovan, Department of Medicine, University of Rochester Medical Center, Rochester, NY 14642, United States
David Jerez Diaz, Department of Internal Medicine, Florida State University, Sarasota Memorial Hospital, Sarasota, FL 34239, United States
Lana Petrova, Department of Internal Medicine, University of Rochester Medical Center, Rochester, NY 14642, United States
Anuroop Yekula, Patrick Twohig, Department of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, NY 14642, United States
Author contributions: Liu C, Elangova A, Diaz DJ, Petrova L, Yekula A, and Twohig P conducted the literature review and drafted the manuscript; Liu C and Twohig P made critical revisions; Twohig P designed the overall concept and outline of the manuscript. All authors approve the final version to publish.
AI contribution statement: The authors take full responsibility and accountability for all content of this manuscript, including any portions for which AI tools were used as assistive technologies. All AI-assisted outputs were carefully reviewed, validated, and approved by the authors. AI tools were not used to generate original scientific data, perform independent scientific analyses, or draw scientific conclusions.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Patrick Twohig, MD, Assistant Professor, FRCPC, Department of Gastroenterology and Hepatology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, United States. patrick_twohig@urmc.rochester.edu
Received: March 12, 2026 Revised: June 5, 2026 Accepted: June 26, 2026 Published online: September 18, 2026 Processing time: 184 Days and 3.3 Hours
Core Tip
Core Tip: Cholestatic pruritus is a common and debilitating symptom in cholestatic liver diseases such as primary biliary cholangitis and primary sclerosing cholangitis. Its pathogenesis is multifactorial, involving bile acids, autotaxin-lysophosphatidic acid signaling, and endogenous opioids. This systematic review summarizes contemporary diagnostic approaches and treatment strategies. Serum autotaxin correlates moderately with itch severity but should be interpreted alongside validated clinical pruritus scales. While bile acid sequestrants remain the traditional first-line therapy due to safety, evidence for efficacy is limited. Fibrates show increasing effectiveness, particularly in primary biliary cholangitis and primary sclerosing cholangitis. Rifampin, opioid antagonists, sertraline, and newer ileal bile acid transporter inhibitors provide options for refractory disease. A stepwise, multidisciplinary approach is essential to optimize outcomes.
