UNEXPECTED CLINICAL REMISSION OF CHOLESTASIS AFTER RIFAMPICIN THERAPYIN PATIENTS WITH NORMAL OR SLIGHTLY INCREASED LEVELS OF GAMMA-GLUTAMYL-TRANSPEPTIDASE

Objective: Rifampicin is an effective drug against pruritus in intrahe patic cholestasis. However, there is no specific hepatic disease in wh ich its use could cause undoubtedly biochemical improvement. The aim o f this study was to describe patients with complete remission of chole static symptoms after rifampicin therapy. Methods: We reported three f emale patients with intrahepatic cholestasis with no evidence of viral , metabolic, or autoimmune liver diseases. Total bilirubin levels rang ed from 13.2 to 27.2 mg/dl (before the first treatment,vith rifampicin ), and in ail of them gamma-glutamyl transpeptidase values were within the normal range or slightly increased. Rifampicin therapy was admini stered orally, without any concomitant drug, with an effective dosage of 5-17 mg/kg/day, Results: In all patients, pruritus ceased completel y and bilirubin returned to normal values, The symptoms recurred after rifampicin withdrawal on, at least, three occasions in each patient, and these symptoms were always eliminated after its reintroduction, Th e patients had a total of 16 cholestatic episodes during a follow-up o f 8 yr, with a complete clinical recovery in all of them. Undergoing t herapy with a suitable dosage of rifampicin, none of the patients had a cholestatic crisis even during a period for as long as 12 months. Th e diagnosis of two patients was consistent with benign recurrent intra hepatic cholestasis, and it was not well defined in the remaining. Con clusion: Rifampicin may induce clinical remission, and perhaps prevent clinical relapses of intrahepatic cholestasis with normal or slightly increased levels of gamma-glutamyl transpeptidase, (Am J Gastroentero l 1998;93: 1510-1517, (C) 1998 by Am. Cell. of Gastroenterology).