8 WORLD GASTROENTEROLOGY NEWS JULY 2016 Editorial | Expert Point of View | Gastro 2016: EGHS-WGO | WDHD News | WGO & WGOF News | WGO Global Guidelines | Calendar of Events Etiology The cause of ICP is currently un-known, but genetic, hormonal, and environmental factors are involved, as suggested by the higher prevalence seen in certain ethnic groups (Swed-ish, Chilean, and Araucanian Indi-ans); an increased incidence in late pregnancy and multiple pregnancies with precipitation by exogenous pro-gestogens; and the possible association with low selenium levels. ICP usu-ally appears in the third trimester of pregnancy when estrogen production reaches its maximum levels 1, 11. Genetic influences play a role, with a strong family tendency (between 10- 16% of mothers, sisters, or daughters of previous ICP patients had had liver dysfunction during pregnancy) and the more recent discovery of some specific gene mutations in some ICP cases 13-16. Genetic defects in at least six canalicular transporters have been found, which may lead to an increased sensitivity to estrogen which Author Year Country Period Number of ICP Figure 1. Mechanisms involved in the multifactorial pathogenesis of intrahepatic cholestasis of pregnancy. Adapted and modified by permission from Zapata R, Glasinovic JC. Intrahepatic cholestasis of pregnancy. In Perez-Sanchez, Donoso E (Eds): Clini-cal Obstetrics. Chile, Mediterraneo limitada, 2011, p 923). 11 Abreviations: ICP: intrahepatic cholestasis of pregnancy. patients/ total pregnancies Inci-dence of ICP Castaño G, et al 2006 Argentina 2004-2005 41 / 2,596 1.04% Reyes H, et al 1978 Chile 1974-1975 132 / 869 13.2% Ribalta J, et al 1991 Chile 1989-1990 894 / 22,340 4% Lo TK, et al 2007 China 2003-2005 8 / 16,911 0.047% Xiao-Lin L, et al 2015 China 2011 1,276/112,441 1.14% Heinonen S, et al 1999 Finland 1990-1996 91 / 16,909 0.54% Savander M, et al 2003 Finland 1992-1993 69 / 5,304 1.3% Alokananda R, et al 2005 India 2003-2004 32 / 2,668 1.2% Rathi U, et al 2007 India 2002-2004 10 / 12,061 0.082% Roncaglia L, et al 2002 Italy 1989-1997 206 / 20,815 1% Glantz A, et al 2004 Sweden 1999-2002 693 / 45,485 1.5% Laifer SA, et al 2001 USA 1997-1999 20 / 6,250 0.32% Lee RH, et al 2006 USA (Latinos) 1997-1998 19 / 340 5.6% Table 1. Studies showing the incidence of intrahepatic cholestasis of pregnancy in different countries. Adapted, updated and modified by permission from Zapata R, Glasinovic JC. Intrahepatic cho-lestasis of pregnancy. In Perez-Sanchez, Donoso E (Eds): Clinical Obstetrics. Chile, Mediterraneo limitada, 2011, p 921. 11 Abreviations: ICP: intrahepatic cholestasis of pregnancy.
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