Oral guar gum, a gel-forming dietary fiber relieves pruritus in intrahepatic cholestasis of pregnancy

Background. Guar gum is a gel-forming fiber, which increases fecal eliminat ion of bile acids. It may therefore be beneficial in the treatment of intra hepatic cholestasis of pregnancy. Methods. Forty-eight patients with intrahepatic cholestasis of pregnancy we re randomized double-blind to receive either guar gum or placebo until deli very. Serum bile acid concentration was measured. Pruritus was assessed by both the investigator and the patient. Results. At baseline, the intensity of pruritus and the serum bile acid con centration were significantly related. Guar gum diminished or prevented wor sening of pruritus, while in the placebo group pruritus was enhanced (p<0.0 5). In the placebo group serum bile acid concentration increased significan tly, whereas in the guar gum group it remained unchanged (p<0.05 between th e groups). Guar gum treatment-induced changes of the pruritus score and ser um bile acid concentrations were significantly related (p<0.01). Conclusions. Guar gum relieved the intensity of pruritus without any side e ffects and prevented the rise in serum bile acid concentration in this plac ebo-controlled and double-blind study of patients with intrahepatic cholest asis of pregnancy.