Cholestasis is a condition (not a disease) where bile cannot flow from the liver to the duodenum. The two basic distinctions are an obstructive type of cholestasis where there is a mechanical blockage in the duct system that can occur from agallstone 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. Based on the defect location, cholestasis can be segmented as extrahepatic cholestasis and intrahepatic cholestasis.
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Itchiness 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 itchiness due to cholestasis. Although jaundice is an uncommon occurrence in intrahepatic (metabolic) cholestasis, but is common in obstructive cholestasis. Pale stool and dark urine are the other symptoms of obstructive cholestasis.
Bile duct tumors, pancreatitis, stones in the common bile duct, pseudocyst or pancreatic tumor, pancreatic cysts and primary sclerosing cholangitis are some of the major causes for extrahepatic cholestasis.Intrahepatic cholestasis is usually caused by hepatitis or by medications that can produce symptoms resemblinghepatitis. Intrahepatic cholestasis is also caused due to amyloidosis, bacterial abscess in the liver, lymphoma, alcoholic liver disease, pregnancy, primary sclerosing cholangitis, tuberculosis (TB), viral hepatitis and sarcoidosis. Sometimes, certain medications also result in cholestasis that include anabolic steroids, tolbutamide, prochlorperazine, estradio, terbinafine, imipramine, chlorpromazine, birth control pills and cimetidine. Cholestasis occurs in about one out of thousand pregnancies but is more common in Swedish and Chilean ethnic groups.
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Cholestasis can be diagnosed through CT scan, MRI scan, ultrasound and endoscopic retrograde cholangiopancreatography. Blood test will also enable physicians to determine the volume of bilirubin, and alkaline phosphatase and hence will be able to diagnose cholestasis. Cholestasis often do not respond to medical therapy, however, ursodeoxycholic acid has proven its success in increasing the secretion of bile in children to cure the disease. Liver transplantation is also performed to treat cholestasis. The market for cholestasis will grow owing to rising incidences of various diseases such as cancer, TB and lymphoma.
The World Health Organization (WHO) has estimated that approximately 1.5 million people died of 9.6 million people who suffered from tuberculosis (TB) worldwide in 2014. Similarly, changing lifestyle has altered dietary pattern that will also propel the growth of this market.
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