The prevalence of intrahepatic cholestasis in chronic liver disease is still undefined. In this study we evaluated the prevalence and the clinical features of the cholestasis syndrome in 3210 liver disease patients from south Italy, hospitalized in the last 7 years in the Liver Unit of the Medical School of University of Naples. An increase in serum alkaline phosphatase, with or without an increase in serum GGT, was found in 556 subjects (17% of the cases), 64% of whom had also an increase in serum bilirubin. Seventy per cent of cholestatic patients were affected by chronic hepatitis with or without cirrhosis, while 6% were affected by primary biliary cirrhosis or sclerosing cholangitis. A comparison of these results with a multicenter Italy/London study revealed that cholestasis was less frequent in South Italy (7% of chronic hepatitis and 19% of cirrhosis) than in the general survey from Italy (15% and 41%) and from England (30% and 48%). The different etiology and dietary and environmental factors in the different regions compared may account for these discrepancies.