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Interventions for treating cholestasis in pregnancy

Obstetric cholestasis is a liver disorder in pregnancy that appears most often in the third trimester of pregnancy. The main symptom of this condition is itching (pruritus), which can be quite distressful to the pregnant woman. Bile acids accumulate within the liver and the blood level of bile acids are raised. The signs and symptoms spontaneously clear within the first few days after birth, or within two to three weeks. This condition is associated with preterm birth and is thought to be associated with complications in the unborn babies, including stillbirth. Most clinicians deliver babies early to reduce the risk of stillbirth. Therapies such as ursodeoxycholic acid (UDCA) and S‐adenosylmethionine (SAMe) seek to detoxify bile acids, or to change how they dissolve. Some agents (activated charcoal, guar gum, cholestyramine) have been used to bind bile acids in the intestine and thus get rid of them. Some of these agents have potential adverse effects for mothers due to the depletion of vitamin K, required for blood clotting.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2014

Interventions for treating intrahepatic cholestasis in people with sickle cell disease

We aimed to review the evidence for treating intrahepatic cholestasis (liver diseases where bile is either not formed or excreted properly (or both)) in people with sickle cell disease.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2015

Antibiotics may prevent complications following endoscopy of the bile or pancreatic ductal systems

Endoscopic retrograde cholangiopancreatography (ERCP) involves cannulating the biliary system in order to diagnose bile or pancreatic duct obstruction. It then affords the possibility of relieving this obstruction using various interventions. Traditionally, prophylactic antibiotics have been administered to decrease the incidence of infective complications as a result of interfering with a normally sterile biliary tree. Preventing overuse of antibiotics and consequent bacterial resistance must be aimed. If antibiotics do not prevent complications following ERCP, then antibiotics should not be used.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

Endoscopy for the treatment of acute gallstone pancreatitis

Acute pancreatitis refers to sudden inflammation of the pancreas associated with severe abdominal pain. The most common cause is transient blockage of the pancreatic or bile duct (or both) by gallstones. Most attacks of acute pancreatitis are mild, and most patients recover uneventfully with medical management. However, a small proportion of patients have a more severe course requiring intensive medical management.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2012

Still awaiting evidence for effect of ursodeoxycholic acid and/or antibiotics in the prevention of biliary stent occlusion

Malignant occlusion of the biliary tract can be relieved by insertion of a stent, which allows passage of the biliary fluid. However, stents often clog. This Review examines if ursodeoxycholic acid (a bile acid) and/or antibiotics may prevent clogging of biliary stents. At present there is not sufficient evidence to recommend ursodeoxycholic acid and/or antibiotics for biliary stented patients.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

No evidence to support or refute endoscopic retrograde cholangiopancreaticography (ERCP) with stenting in patients with malignant pancreaticobiliary diseases, awaiting surgery

Pancreatico‐biliary malignancy includes cancers of pancreas, ampulla, duodenum, and cholangiocarcinoma. There is significant morbidity and mortality related to surgery in these patients. Studies have claimed the beneficial role of biliary decompression, which can be performed via endoscopic retrograde cholangiopancreaticography (ERCP) with stent insertion pre‐surgically. The review found that pre‐surgical biliary stenting via ERCP did not improve the morbidity and mortality in patients with pancreatico‐biliary malignancy. Further evidence about its efficiency is needed.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2009

Palliative biliary stents for obstructing pancreatic cancer

The majority of patients with cancer of the pancreas are diagnosed only after blockage of the bile ducts has occurred. Surgical by‐pass (SBP) or endoscopic stenting (ES) of the blockage are the treatment options available for these patients. This review compares 29 randomised controlled trials that used surgical by‐pass, endoscopic metal stents or endoscopic plastic stents in patients with malignant bile duct obstruction. All included studies contained groups where cancer of the pancreas was the most common cause of bile duct obstruction. This review shows that endoscopic stents are preferable to surgery in palliation of malignant distal bile duct obstruction due to pancreatic cancer. The choice of metal or plastic stents depends on the expected survival of the patient; metal stents only differ from plastic stents in the risk of recurrent bile duct obstruction. Polyethylene stents and stainless‐steel alloy stents (Wallstent) are the most studied stents.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2011

Insufficient evidence to support or refute glucocorticosteroids for primary sclerosing cholangitis

Primary sclerosing cholangitis is a chronic cholestatic disease of intrahepatic and extrahepatic biliary ducts, characterised by chronic periductal inflammation and sclerosis of the ducts, which results in segmental stenoses of bile ducts, cholestasis, fibrosis, and, ultimately, liver cirrhosis. Patients with primary sclerosing cholangitis are at higher risk of cholangiocarcinoma as well as of colonic neoplasia, since primary sclerosing cholangitis is associated with inflammatory bowel disease in more than 80% of patients. Several therapeutic modalities have been proposed for primary sclerosing cholangitis, like ursodeoxycholic acid, glucocorticosteroids and immunomodulatory agents, but none has been successful in reversing the process of the disease. To date, liver transplantation is the only definite therapeutic solution for patients with advanced primary sclerosing cholangitis with liver cirrhosis.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: 2010

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