Clinical studies on dissolution of gallstones using ursodeoxycholic acid

Abstract

Ursodeoxycholic acid (UDCA), 7beta hydroxy epimer of chenodeoxycholic acid (CDCA), has been used as a choleretica for 20 years in Japan. Recent report showing increased excretion of UDCA in bile after CDCA administration may suggest the possibility that UDCA has similar effects to CDCA on bile cholesterol unsaturation and on gallstone dissolution. The present paper describes the clinical usefulness of UDCA for gallstone patients during the past two years. Seventy-four gallstone patients with functioning gall-bladders, 19 men and 55 women with a mean age of 48 years, have been treated for 6 months or more. UDCA, supplied in tablets (Ursosan), was given 450 mg per day. The disappearance or the reduction of stone size or number, or both (dissolution effect) was recognized in 32 out of 74 patients (43%). In case of radiolucent stones, the overall effective rate was estimated for 24 of 46 patients (52%). There may be no significant difference in dissolution effect between CDCA and UDCA treatment, however, the merit of UDCA treatment seems to have its few side effects.

Ursodeoxycholic Acid for the Dissolution of Radiolucent Gall Bladder Stones

“…Our overall success rate of 19% of patients achieving complete dissolu tion, or 25% of those treated for at least 6 months, is comparable with other studies [2,3,9,13,20,22], using various doses of UDCA, usually for only 6-12 months. Equal efficacy for the lower dose was confirmed in the separate analysis of stones less than 10 mm in diameter, which fact is important as our results confirm previous findings that stone size is a significant predictor of re sponse to UDCA [13,22], Interpretation of other published dose comparison studies of UDCA evaluating gall-stone dissolution rather than biliary lipid changes is not easy as several such studies are of small numbers of patients, or follow-up has been limited, with extensive use of partial dissolution as an end-point.…”

Treatment of Radiolucent Gallstones with CDCA or UDCA

“…Simi lar results have more recently been reported with ursodeoxycholic acid (UDCA) [3,4]. This drug seems to be active even if adminis tered for a shorter time or in smaller doses than CDCA [5][6][7], This paper reports the results of a multi center study carried out on 116 patients in some Lombard hospitals on the litholytic ac tivity of CDCA and of two different doses of UDCA.…”

Analysis of Response to Ursodeoxycholic Acid for Gallstone Dissolution

“…Al though gallstone size is believed to be impor tant by some groups using either CDCA therapy (14,21) or UDCA (19,20), others have not found size to be of much (23) or indeed any (4) importance in determining outcome. There is no reason why larger stones should be resistant to dissolution therapy although, of course, a complete response may reasonably be expected to take longer.…”

“…Chenodeoxycholic acid (CDCA) has been shown to dissolve gallstones most effectively with large doses (15 mg/kg body weight, or 1,000 mg/day) (2, 4. 10, 14, 23); but it has been suggested that UDCA may be more potent (19,20) and relatively smaller doses might be optimal. An analysis of the biliary lipids indicated that UDCA treatment reduced biliary cholesterol in gallstone disease (5,16,17,19,22) although cholesterol satura tion was reduced inconsistently by lower doses (5).…”

“…Ursodeoxycholic acid (UDCA) has been re ported as an effective agent to dissolve choles terol gallstones (19,20) but the ideal dose has not been identified. Chenodeoxycholic acid (CDCA) has been shown to dissolve gallstones most effectively with large doses (15 mg/kg body weight, or 1,000 mg/day) (2, 4.…”