7 WORLD GASTROENTEROLOGY NEWS JULY 2016 Editorial | Expert Point of View | Gastro 2016: EGHS-WGO | WDHD News | WGO & WGOF News | WGO Global Guidelines | Calendar of Events Intrahepatic Cholestasis of Pregnancy: Even Today a Puzzling Disease of Pregnancy Introduction Intrahepatic cholestasis of pregnancy (ICP) is a cholestatic liver disease unique to pregnancy 1-4 with a vari-able worldwide prevalence ranging approximately between 0.3 and 5.6% of pregnancies 3, 5, 6. Its prevalence var-ies greatly according to country and ethnic group, being more common in countries like Chile and Bolivia 7. It is considered the most common pregnancy-related liver disorder 2, 6. It usually presents during the second and third trimester of pregnancy and is clinically defined by an annoying persistent pruritus (specially involving the palms and soles) and biochemi-cally by elevated serum total bile acid levels and/or abnormal serum liver tests, in the absence of primary skin lesions, which resolves completely in the following few days after delivery. The cause of ICP is unknown, but genetic, hormonal, and environmen-tal factors are likely involved 8, 9. The importance of its timely recognition is related to an increased risk of stillbirth and preterm delivery with its associ-ated mortality and morbidity for the newborn 2, 3. Therefore, early recogni-tion, treatment, and timely delivery are imperative. The major clinical features, diagnosis, and treatment of intrahepatic cholestasis of pregnancy will be reviewed here. Twenty year ago, after ending my GI fellowship at the Catholic University of Chile, I moved to the University of Chile, where I started my academic carrier. At that time I joined the clini-cal research team of Dr. Humberto Reyes, a Chilean world recognized expert in the field of ICP and who later became one of my mentors. At that time he wrote a very nice review paper titled “Intrahepatic cholestasis: A puzzling disorder of pregnancy” 1, where he described the state of the art of ICP at that moment, emphasizing its unknown cause and the possible mechanistic interplay between a genetic metabolic predisposition of affected patients and “some” environ-mental factor(s). He also described how mysteriously the ICP incidence significantly decreased in Chile from 1975 (14% of deliveries) to 1995 (only 4% of deliveries). Twenty years later, ICP remains a “puzzling disease of pregnancy,” even though many signifi-cant advances have been made in the pathogenesis and understanding of this intriguing disease. Epidemiology The incidence of ICP varies greatly throughout the world. Evidence of family clustering and the different prevalence in certain ethnic groups may partially explain the geographic variation in its incidence. ICP is more common in South America (especially Chile), South Asia, and in Scandina-vian countries 3, 10, 11. Recent studies have shown that in the United States the incidence varies widely (between 0.32 to 5.6%), because of its hetero-geneous population 5. Table 1 shows the incidence rate of ICP in different countries. ICP has also been shown to be more frequent in pregnant women with more advanced age, multiparous women, and in those with a per-sonal history of cholestasis due to oral contraceptive use 1, 3. In addition, the prevalence of ICP has been shown to be five times greater in twin pregnan-cies than in singleton pregnancies 12. ICP also shows seasonal variation, occurring more frequently in the cold winter months. Rodrigo Zapata MD, FAASLD Associate Professor of Medicine Gastroenterology Department & Liver Unit University of Chile School of Medicine, Eastern Campus, Hospital Del Salvador. & Clínica Alemana de Santiago, Universidad del Desarrollo, Santiago, Chile. Member WGO Global Guidelines Committee 2015-2017 NOW ONLINE - E-WGN EXPERT POINT OF VIEW ARTICLES COLLECTION! Did you enjoy this expert point of view article? We invite you to check out the entire collection of Scientific and Ex-pert Point of View articles from e-WGN from the past five years on the new WGO website. You can view this article and more at www.worldgastroenterology.org/publications/e-wgn/e-wgn-expert-point-of-view-articles-collection.
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