Multicentre Survey of the Prevalence of Intrahepatic Cholestasis in 2520 Consecutive Patients with Newly Diagnosed Chronic Liver Disease

In order to establish the prevalence of intrahepatic cholestasis (IHC) in chronic liver disease, we retrospectively evaluated the frequency of increased serum total bilirubin (STB), serum conjugated bilirubin (SCB) and serum alkaline phosphatase (SAP) levels in a cohort of 2520 patients with newly diagnosed chronic liver disease presenting over 2 years. 882 patients (35%) [mean age 52.2 years] had IHC involving abnormal levels of STB (mean 89.8 μmol/L), SCB (mean 52.5 μmol/L), and SAP (mean 5.7 μkat/L) together with a negative ultrasonic scan. Demographic data were not predictive of IHC. IHC was more frequent in patients with cirrhosis (43%), primary biliary cirrhosis (54%), and primary sclerosing cholangitis (67%) than in those with chronic persistent hepatitis (17%) and chronic active hepatitis (32%). 611 of 882 patients (69%) were symptomatic; there were 3 times more patients with jaundice than there were with pruritus (64 vs 22%). Age, sex and liver disease stage did not predict the occurrence of symptomatic IHC. Increased serum bilirubin was related to the presence of jaundice but not pruritus. The prevalence of IHC was similar in the geographical regions involved in the study (34.5% in Italy vs 35.6% in the UK). In conclusion, IHC is a common complication of chronic liver disease, being more frequent in advanced disease. Pruritus is a predominant complaint in 1 of 4 patients with IHC and is unrelated to IHC severity.