Endoscopic nasobiliary drainage: an effective treatment option for benign recurrent intrahepatic cholestasis (BRIC)

BMJ Case Rep. 2017 May 5:2017:bcr2016218874. doi: 10.1136/bcr-2016-218874.

Abstract

Benign recurrent intrahepatic cholestasis (BRIC) is characterised by recurrent episodes of jaundice, severe pruritus and low or normal serum γ-glutamyltransferase activity lasting from several weeks to months. BRIC is an autosomal recessive disorder caused by the mutation in either of the two hepatic transporter genes-ATP8B1 or ABCB11 gene. The disease is very well known for episodic flare of jaundice with cholestatic symptoms that are spontaneous or perpetuated by acute insults, followed by self-recovery. There is no proven medical therapy and rarely does it progress to progressive familial intrahepatic cholestasis (PFIC) or biliary cirrhosis. BRIC may be associated with nephrolithiasis, diabetes or pancreatitis. Here, we report a case of BRIC with spontaneous flare and further complicated by drug-induced liver injury with disabling cholestastic symptoms, who underwent endoscopic nasobiliary drainage and was completely relieved of the distressing symptoms.

Keywords: Endoscopy; Gastroenterology.

Publication types

  • Case Reports

MeSH terms

  • ATP Binding Cassette Transporter, Subfamily B, Member 11
  • Adenosine Triphosphatases
  • Chemical and Drug Induced Liver Injury / complications*
  • Cholestasis / diagnosis*
  • Cholestasis / etiology
  • Cholestasis, Intrahepatic / complications
  • Cholestasis, Intrahepatic / diagnosis*
  • Cholestasis, Intrahepatic / genetics
  • Cholestasis, Intrahepatic / pathology
  • Cholestasis, Intrahepatic / physiopathology
  • Cholestasis, Intrahepatic / therapy
  • Drainage / methods*
  • Endoscopy / methods*
  • Humans
  • Jaundice / diagnosis*
  • Jaundice / etiology
  • Male
  • Mutation
  • Pruritus / diagnosis*
  • Pruritus / etiology
  • Recurrence
  • Treatment Outcome
  • Young Adult
  • gamma-Glutamyltransferase / blood

Substances

  • ATP Binding Cassette Transporter, Subfamily B, Member 11
  • gamma-Glutamyltransferase
  • Adenosine Triphosphatases
  • ATP8B1 protein, human

Supplementary concepts

  • Cholestasis, progressive familial intrahepatic 1