Successful management of severe intrahepatic cholestasis of pregnancy: report of a first Japanese case.

Abstract

BACKGROUND:

Intrahepatic cholestasis of pregnancy (ICP) is a cholestasis condition caused by elevated levels of serum bile acids that mainly occurs in the third trimester of pregnancy. Maternal symptoms include pruritus; elevation of transaminases, biliary enzymes, and bilirubin levels; and abnormal liver function tests. Fetal symptoms include spontaneous preterm labor, fetal distress, and intrauterine death. It is more prevalent in the Caucasians and is rarely found in Asian countries, including Japan. The etiology of ICP has been reported as involving various factors such as, environmental factors, hormone balance, and genetic components. The genetic factors include single-nucleotide polymorphisms (SNPs) in the genes of canalicular transporters, including ABCB4 and ABCB11. It has also been reported that the combination of these SNPs induces severe cholestasis and liver dysfunction.

CASE PRESENTATION:

Here, we report for the first time a 24-year Japanese case of severe ICP diagnosed by typical symptoms, serum biochemical analysis, and treated with the administration of ursodeoxycholic acid which improved cholestasis and liver injury and prevented fetal death. The sequence analysis showed SNPs reported their association with ICP in the ABCB11 (rs2287622, V444A) and ABCB4 (rs1202283, N168N) loci.

CONCLUSION:

The risk of ICP has been reported to be population-specific, and it is rare in the Japanese population. Our case was successfully treated with ursodeoxycholic acid and the genetic sequence analysis has supported the diagnosis. Because genetic variation in ABCB4 and ABCB11 has also been reported in the Japanese population, we need to be aware of potential ICP cases in pregnant Japanese women although further studies are necessary.

• Authors: Kenya Kamimura, Hiroyuki Abe, Naomi Kamimura, Masayuki Yamaguchi, Maiko Mamizu, Kanna Ogi, Yoshifumi Takahashi, Ken-Ichi Mizuno, Hiroteru Kamimura, Yuji Kobayashi, Manabu Takeuchi, Kunihiko Yoshida, Kyoko Yamada, Takayuki Enomoto, Koichi Takakuwa, Minoru Nomoto, Miki Obata, Yoshinori Katsuragi, Yukio Mishima, Ryo Kominami, Tomoteru Kamimura, Yutaka Aoyagi
• Journal: BMC gastroenterology (BMC Gastroenterol) Vol. 14 Pg. 160 (Sep 13 2014) ISSN: 1471-230X [Electronic] England
• PMID: 25218883 (Publication Type: Case Reports, Journal Article)

Chemical References

• Cholagogues and Choleretics
• Ursodeoxycholic Acid

Topics

• Asian People
• Cholagogues and Choleretics (therapeutic use)
• Cholestasis, Intrahepatic (drug therapy)
• Female
• Humans
• Pregnancy
• Pregnancy Complications (drug therapy)
• Treatment Outcome
• Ursodeoxycholic Acid (therapeutic use)
• Young Adult