Plasma Bile Salt Levels in Patients Presenting with Generalised Pruritus: An Improved Indicator of Occult Liver Disease

Fasting plasma bile salt concentrations were measured in 26 patients presenting to a Skin Department who had generalised pruritus without primary skin disease, as part of a screening investigation for systemic causes of pruritus. The results were compared with conventional tests of hepatic function. Plasma-conjugated cholate measurements identified all patients with hepatobiliary disease. Conventional liver function tests were abnormal in these patients but also in five patients with no other evidence of hepatic dysfunction. Fasting conjugated-cholate measurements offer a useful screening test for identifying hepatobiliary disease in patients presenting with generalised pruritus.