Pruritus scores and gamma glutamyl transferase pattern in calcular and malignant biliary obstruction

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Abstract Background This study evaluated the relationship between cholestatic biomarkers and pruritus severity, as well as the impact of pruritus on quality of life in patients with biliary obstruction. Patients and methods A cross-sectional observational study enrolled 110 patients: Group A, patients with calcular biliary obstruction, and Group B, patients with malignant biliary obstruction. Demographic, clinical, and laboratory data were collected, including cholestatic biomarkers, a visual analogue scale score, and a five-dimensional (5D) pruritus scale, which were used to assess pruritus severity, and the 36-item Short Form-36 health survey was used to evaluate the impact of pruritus on quality of life. Results Patients with malignant biliary obstruction (group B) presented with more advanced clinical manifestations than those with calcular biliary obstruction (group A), including greater weight loss, pruritus, hepatomegaly, higher bilirubin levels, more advanced imaging findings, and significantly higher pruritus severity scores. Pruritus severity correlated positively with bilirubin levels and negatively with health-related quality of life (HRQOL), particularly in group B. In contrast, higher GGT levels and GGT/direct bilirubin ratios were consistently observed in non-pruritic patients and showed a strong inverse correlation with pruritus severity. Overall, malignant obstruction and pruritus were linked to greater biochemical derangement and substantial impairment in physical and mental health-related quality of life. Conclusion Pruritus was more frequent and severe in malignant biliary obstruction and was strongly associated with impaired quality of life. GGT and the GGT/direct bilirubin ratio showed a strong negative correlation with pruritus severity, highlighting a potential inverse association with the severity of pruritus.

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