People with primary biliary cholangitis (PBC) often struggle with chronic itching, known as pruritus, which can greatly affect daily life. The bile-acid lowering medication cholestyramine may ease this symptom not just by removing bile acids, but also by improving gut health, according to a recent study published in the journal Microbiology Spectrum.
The study followed 54 people with PBC who had itching and compared them with 25 people who had PBC but no itching. Patients with itching took cholestyramine (4 grams, twice a day) for four weeks. The researchers checked how bad the patients’ itching was and also tested their blood and their stool.
Results showed that cholestyramine significantly reduced itching. Average itch scores dropped from 20 to 7, and levels of autotaxin — an enzyme (protein) linked to itching — were cut by more than half. Liver enzyme levels, including alkaline phosphatase, gamma-glutamyl transferase and bilirubin, also improved.
Stool tests showed that before treatment, patients with itching had fewer healthy gut bacteria and more harmful bacteria compared with symptom-free individuals. They also had lower levels of chemicals made by helpful bacteria. After cholestyramine treatment, levels of helpful gut bacteria and chemicals increased, while levels of harmful gut bacteria decreased.
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The researchers also found that not all patients responded equally well. Those who had fewer harmful bacteria and lower levels of long-chain fatty acids before treatment showed the most improvement in itching after treatment.
The findings suggest that itching in people with PBC is linked to problems in how the gut and liver work together. When this “gut-liver connection” is not working well, bile acids made by the liver, gut bacteria and gut chemicals become unbalanced, causing itching. Cholestyramine helps reduce itching by fixing this balance.
“To our knowledge, this represents the first comprehensive analysis of cholestyramine’s impact on gut microbial ecology and associated metabolic pathways specifically in pruritic PBC patients,” the researchers said.
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