1. Pruritus was assessed in 19 patients by measurement of nocturnal limb movement.
2. Serum (nine pruritic, ten non-pruritic) and interstitial fluid (five pruritic, three non-pruritic) bile acids were fractionated according to their mode of conjugation by using DEAP-Sephadex LH-20 and measured by gas chromatography—mass spectrometry.
3. No correlation was found between serum or interstitial fluid total bile acid or individual bile acid concentrations and pruritus. Bile acid profiles in the two groups of patients were similar and there was no correlation between pruritus and the conjugation pattern.
4. The bile acid profile of interstitial fluid reflected that of serum and a linear relationship was found between serum and interstitial fluid bile acid concentrations (r = 0·95, P < 0·001).
5. The proportion of bile acid sulphate in interstitial fluid was significantly smaller than that in serum (P < 0·025), where sulphates accounted for up to 46% of the total bile acids.
6. In three patients, a decrease in serum bile acid concentrations achieved by percutaneous transhepatic biliary drainage had little or no effect on pruritus.
7. These findings suggest that bile acids do not have a causative role in the pruritus of cholestatic liver disease.