Publication Name	World Journal of Meta-Analysis
Manuscript ID	120937
DOI	10.13105/wjma.120937
Country	United States

Category	Gastroenterology & Hepatology
Manuscript Type	Systematic Reviews
Article Title	Scratching the surface: A systematic review of modern approaches to diagnosing and treating cholestatic pruritus
Manuscript Source	Invited Manuscript
All Author List	Catherine Liu, Ashwath Elangovan, David Jerez Diaz, Lana Petrova, Anuroop Yekula and Patrick Twohig
Funding Agency and Grant Number
Corresponding Author	Patrick Twohig, Assistant Professor, FRCPC, MD, Department of Gastroenterology and Hepatology, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, NY 14642, United States. patrick_twohig@urmc.rochester.edu
Key Words	Cholestatic pruritus; Primary biliary cholangitis; Primary sclerosing cholangitis; Hepatobiliary diseases; Ileal bile acid transporter inhibitors
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.
Citation	Liu C, Elangovan A, Diaz JD, 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; In press DOI: https://doi.org/10.13105/wjma.120937
PDF	120937-in-press.pdf

Received	2026-03-12 06:08
Peer-Review Started	2026-03-12 06:10
First Decision by Editorial Office Director	2026-05-18 06:45
Return for Revision	2026-05-22 02:23
Revised	2026-06-05 02:12
Publication Fee Transferred
Second Decision by Editor	2026-06-26 02:17
Second Decision by Editor-in-Chief
Final Decision by Editorial Office Director	2026-06-26 02:43
Articles in Press	2026-06-26 02:43
Edit the Manuscript by Language Editor
Typeset the Manuscript

ISSN	2308-3840 (online)
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