Managing Fatigue and Pruritus in Primary Biliary Cholangitis: A Stepwise Approach

Announcer:
Welcome to GI Insights on ReachMD. On this episode, we’ll hear from Ms. Allysa Saggese, who’s a nurse practitioner at Weill Cornell Medicine’s Center for Liver Disease and Transplantation. She’ll be discussing how we can manage symptoms and improve the quality of life of patients with primary biliary cholangitis. Here’s Ms. Saggese now.

Dr. Saggese:
So some of the most challenging symptoms to manage in our PBC patients are the fatigue and itch. It is sometimes very difficult to create and tailor treatment plans to address these symptoms effectively. Some of the things we do is first make sure that we are not missing another diagnosis that might be causing these issues and making sure they’ve had a full workup for any other issues that could be causing fatigue, making sure they’ve seen a dermatologist for itch; although, we do usually presume, and probably rightfully so, that it's coming from PBC. So we try to manage it as best as we can with the patient. We have close follow-up. We discuss all the kinds of treatments that we can offer, both pharmacological and non-pharm, and go with what the patient wants to do and wants to try stepwise. We’re trying the nonpharmacological methods first. It’s all according to how the patient directs us. We do it as a collaborative plan and treatment.

So to start with, when we are trying to manage pruritus, which might possibly be the easier one to manage, the nonpharmacological treatments that we’ll start with are making sure you stay hydrated as the person who’s feeling itchy, making you’re sure drinking enough water in a day, and making sure that you’re staying lotioned. It’s very simple things sometimes. We tell them not to take very hot showers and just try to keep the temperature down. They can even do something like an oatmeal bath, which sounds very old-fashioned, but it does work for some people.

The next step after that I think of as easy medicines, which are usually over the counter, so allergy medicines can really help itch in some people, things that we find commonly like Allegra, Claritin, and Zyrtec. Benadryl is also effective, but it is very sedative, and it’s not good to use long term, so I will give people that option to try it out at first to use at night, not during the day. It does also help address maybe another common issue, which is sleep.  Another step up from that would be hydroxyzine, which is prescription. It’s a lot like Benadryl though. It still can make someone sleepy. It should be taken at night. It has maybe higher doses that we can reach than Benadryl. We also might consider creams and lotions that are prescription strength, maybe cortisone corticosteroid-type medications, things in that category. Although that gets to be a little bit out of our specialty to an extent, so it’s nice to have a dermatologist on board if they’re seeing one, and they can also help direct maybe those creams and lotions that we don’t usually take care of but we do agree with as part of their treatment.

As for fatigue, that’s probably the hardest symptom to treat in PBC. There really isn’t a whole lot to be done, unfortunately. It is no good guarantee, and there is no good correlation between treating the disease and getting rid of fatigue, or even pruritus for some people. So we just discuss as best as we can how to manage the way they are dealing with their fatigue and how they are dealing with their day. It sometimes seems counterintuitive, but being as active as possible can help increase your energy and reduce fatigue, but it is a hard hurdle to get over to even get to the point of doing more activities than you usually would.

Announcer:
That was Ms. Allysa Saggese talking about how we can manage primary biliary cholangitis symptoms and improve patients’ quality of life. To access this and other episodes in our series, visit GI Insights on ReachMD.com, where you can Be Part of the Knowledge. Thanks for listening!