Additional Chenodiol Therapy After Partial Dissolution of Gallstones with Two Years of Treatment

Abstract

During the National Cooperative Gallstone Study, therapy with chenodiol, 750 or 375 mg/d, for 2 years resulted in confirmed, complete gallstone dissolution in 14% and 5% of patients, respectively, and partial dissolution (greater than 50%) in 27% and 18%. The present study was done to determine the frequency with which complete dissolution occurs in patients having partial dissolution of gallstones who receive additional therapy. Eighty-six of one hundred thirty-eight eligible patients continued to receive 750 mg/d (61 patients) or 375 mg/d (25 patients) of chenodiol for 1 year. Patients whose oral cholecystogram at the end of the year showed further (greater than 50%) dissolution continued to receive chenodiol, (28 patients at 750 mg/d and 11 patients at 375 mg/d) for a second year (total duration of therapy, 4 years). A final oral cholecystogram was taken at the end of the fourth year. Complete dissolution occurred in 23% and 16% of patients receiving chenodiol, 750 or 375 mg/d, respectively, for an additional 1 or 2 years.

Optimum bile acid treatment for rapid gall stone dissolution.

“…32 We have also shown that bedtime administration of CDCA is more effective than mealtime administration in improving the gall stone dissolution rate. 33 Previous studies have expressed their results in terms of the percentage of patients who achieve partial or complete gall stone dissolution, or both, within a defined time.22-24 26 28 12 34 The disadvantage ofthese studies is that only those patients who achieved complete dissolution are used for statistical analysis, and therefore there is a requirement for large numbers of patients to be enrolled, or for long periods of treatment follow up. This has prevented the demonstration of clearcut differences between the two bile acids.…”

“…12 3/9 47(8) 114(4) (2) UDCA (MT) 12 2/10 55 (6) 107 (5) 11-8 (3) UDCA (BT) 12 4/8 55 (9) 102 (6) 12-3 (3) Combination (BT) 10 2/8 50 (6) 118 (5) 13-2 (2) MT= mealtime; BT= bedtime; IBW= ideal body weight * Results expressed as mean (SEM) 0 0 28 0 0 30 25 38 18 20 30 19 23 52 28 10 10 30 27 27 18 48 80 18 8 8 20 25 40 26 43 65 13 45 50 12 50 100 13 100 100 14 68 90 12 65 78 11 100 100 13 75 93 10 60 80 11 27 52 11 0 0 10 73 73 9 90 95 7 47 80 7 100 100 7 85 85 6 80 92 5 0 0 5 40 56 6 26 76 7 70 90 5 50 70 5 90 100 4 80 100 4 100 100 4 50 100 4 100 100 4 100 100 4 100 100 4 36 56 4 60 78 3 85 85 4 DIA=initial gallstone diameter; DR6 and DR12=dissolution rate at 6 and 12 months respectively; *= DR in this matched quartet of patients is calculated from % reduction in pretreatment gall stone numbers.…”