Comparative Efficacy and Side Effects of Ursodeoxycholic and Chenodeoxycholic Acids in Dissolving Gallstones

Fromm, Hans; Roat, James; González, Víctor H.; Sarva, Rajendra P.; Farivar, Sirus

doi:10.1016/s0016-5085(83)80004-3

Cited by 133 publications

(13 citation statements)

References 38 publications

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“…BAT is undoubtedly the safest current treatment. Although side effects such as diarrhea, hepatotoxicity and increase in low-density lipoprotein were causes for concern when chenodeoxycholic acid was the mainstay of therapy, these problems were virtually eliminated with the introduction of ursodeoxycholic acid and with the use of combined therapy (118)(119)(120)(121)(122)(123)(124)(125). It may be stated that after almost two decades of use no serious complications of the therapy have been reported.…”

Section: Trem'ment Of Symptomatic Cholelithiasismentioning

confidence: 99%

“…Many case series detailing BAT'S ability to cure are available (118)(119)(120)(121)(122)(123)(124)(127)(128)(129)(130). The selection criteria used in these series may be classified as "superoptimal," optimal or acceptable ( Table 2).…”

Section: Trem'ment Of Symptomatic Cholelithiasismentioning

confidence: 99%

“…Many series have used broader selection criteria ( 119, 120,129,130). The "acceptable" criteria are those usually cited as the ones applicable for symptomatic radiolucent gallstones.…”

Section: Trem'ment Of Symptomatic Cholelithiasismentioning

confidence: 99%

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Cholecystolithiasis: Lithotherapy for the 1990S

Strasberg

Clavien

1992

Hepatology

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Cholelithiasis afTects from 10% to 15% of the adult population in industrialized Western countries, with higher prevalence in women, in women with high parity, in the obese, in patients with hypertriglyceridemia and in older patients (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13). In the United States, it has been estimated that 20 to 25 million people have gallstones, and more than 500,000 cholecystectomies are performed annually. Cholecystectomy is the most frequently performed surgical procedure, after cesarean section in this country (141, with an annual cost estimated at $4 to 5 billion. About a quarter of all women will experience cholelithiasis by age 60 in industrialized Western societies; the prevalence in men is about half that of womenThe fist effective treatment for cholelithiasis was cholecystostomy (15, 161, a procedure that was abandoned in the early decades of this century because of the high incidence of stone recurrence. Open cholecystectomy (OC) was introduced more than 100 yr ago (17) and remained the sole effective treatment of this disease for about 90 yr. During this period, the only decision that was required for a patient with cholelithiasis was whether treatment was indicated or not. In the last two decades several new treatments, such as oral bile acid therapy (BAT), extracorporeal shock wave lithotripsy (ESWL) and, more recently, laparoscopic cholecystectomy (LC) have become available. Therefore, it is now not only necessary for physicians to decide whether to treat gallstones but also to recommend the most suitable type of treatment. The purpose of this work is to present an evaluation of the newer therapies (mainly in comparison with OC) including the basis for selection of therapy in individual patients. CLINICAL STAGES OF CHOLELITHIASISCholelithiasis has three clinical stages: the asymptomatic and symptomatic stages and the stage of complications. Complicated forms of cholecystolithiasis include acute cholecystitis and its complications, choledocholithiasis and its complications, gallstone ileus and gallbladder cancer. These complications are much 31/1/40081 more serious than symptomatic cholelithiasis and usually require prompt and invasive treatment. Treatment of the complicated forms of cholelithiasis will not be considered in this work, but it should be noted that it is the avoidance of such complications that constitutes an important rationale for therapy in the symptomatic stage or even under special circumstances in the asymptomatic stage (18)(19)(20)(21)(22)(23)(24)(25).Of critical importance in making recommendations about treatment is knowledge of the natural history of cholelithiasis (i.e., the rate of conversion from the asymptomatic stage to the other stages). Such information is necessary to weigh the risk of expectant management against the hazards of treatment. Historical series on the natural history of gallstones have yielded controversial results, mainly because of the inclusion of many patients with biliary symptoms at the start of the study; this distorts the resu...

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Section: Trem'ment Of Symptomatic Cholelithiasismentioning

confidence: 99%

Section: Trem'ment Of Symptomatic Cholelithiasismentioning

confidence: 99%

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Cholecystolithiasis: Lithotherapy for the 1990S

Strasberg

Clavien

1992

Hepatology

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“…Bile acid therapy (BAT) using chenodeoxycholic acid [15][16][17] or ursodeoxycholic acid (UDCA) [18][19][20][21][22][23][24][25][26][27][28][29][30] has been widely performed as safe nonsurgical therapy of GS. In addition, several studies have suggested that BAT may inhibit GS-related symptoms, [21][22][23]31,32 independent of GS dissolution.…”

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confidence: 99%

Long-term ursodeoxycholic acid therapy is associated with reduced risk of biliary pain and acute cholecystitis in patients with gallbladder stones: A cohort analysis

et al. 1999

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Whether ursodeoxycholic acid (UDCA) therapy alters the long-term clinical course of gallstones (GS) without stone dissolution remains unknown. We aimed to clarify the relationship between long-term UDCA therapy and risks of biliary pain or acute cholecystitis in GS patients. We also aimed to identify factors affecting the natural course, and to explore a simple patient selection criteria for UDCA therapy. A cohort of 527 uncomplicated GS patients with or without UDCA (600 mg/d) followed for up to 18 years was analyzed. Patients who had frequent attacks or were complicated with cholecystitis were converted to cholecystectomy. History and UDCA therapy were identified on Cox analysis as 2 factors affecting the long-term clinical course. In patients without therapy, history was the only predictor of biliary pain among various patient or stone characteristics; biliary pain was rare in asymptomatic patients, while frequent in symptomatic patients (P F .001). UDCA therapy was associated with reduced risk for biliary pain in both symptomatic (62% vs. 92% in untreated patients at 10 years; P F .001; relative risk, 0.19; 95% CI, 0.10-0.34) and asymptomatic patients (6% vs. 12% in untreated patients at 10 years; P ‫؍‬ .037; relative risk, 0.19; 95% CI, 0.04-0.91). Risk for the conversion was also reduced in UDCA-treated symptomatic patients (26% vs. 88% in untreated patients at 10 years, P F .001; relative risk, 0.08; 95% CI, 0.03-0.22). These effects were independent of stone dissolution. Three factors were identified on Cox analysis as affecting GS dissolution: radiolucency, small size (F10 mm) of stones, and visualized gallbladder (GB) on cholecystogram. A selection criteria based on these appears to exhibit high sensitivity (74%) and specificity (95%) for dissolution. UDCA therapy might be considered in symptomatic patients fulfilling these criteria, and also in patients who have significant surgical risk, because the longterm therapy is clearly associated with reduced risk of biliary pain and acute cholecystitis. (HEPATOLOGY 1999;30:6-13.)

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“…Biliary bile acid composition has been changed by the oral administration of chenodeoxycholic acid (CDCA) and ursodeoxycholic acid (UDCA). During this treatmentwhich may cause partial or complete dissolution of gallstonesthe administered bile acid becomes predominant ( 5 ) . Phosphatidylcholine (PC) constitutes in the bile of many animals about 95% of the total phospholipids (6).…”

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confidence: 99%

Effect of dietary phospholipids and their constituents on bile composition in rats and hamsters†

Peled

Gilat

1994

Hepatology

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The formation of cholesterol gallstones is a result of an interaction between bile lipid concentration, composition and other factors. The solubilization of cholesterol in bile is affected by the nature of the fatty acids and head groups of biliary phospholipids. In this study we tried to modulate the composition of biliary lipids in the rat and hamster by means of dietary supplementation of whole phospholipids or their constituents (at 3% to 5% of food weight). A striking effect of ethanolamine feeding in rats and hamsters was demonstrated: Biliary cholesterol concentration and cholesterol saturation index were significantly lower (p < 0.03). In rats, bile acid concentration was increased, contributing to decreased bile lithogenicity. Ethanolamine also increased biliary phospholipid output. Other test substances had less marked effects. The addition of lecithin to rat diet significantly increased phospholipid concentration (p < 0.05) compared with controls. Cholesterol and bile acid concentrations were reduced in palmitic acid-fed hamsters (NS). Choline supplementation insignificantly increased the cholesterol saturation index in hamsters. Despite the clear effect of ethanolamine on biliary lipid composition, no change could be demonstrated in the proportion of phosphatidylethanolamine in bile. It is postulated that ethanolamine was methylated in the liver to choline. Our data demonstrate that biliary lipid composition can be modulated by dietary phospholipids or their components.

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Comparative Efficacy and Side Effects of Ursodeoxycholic and Chenodeoxycholic Acids in Dissolving Gallstones

Cited by 133 publications

References 38 publications

Cholecystolithiasis: Lithotherapy for the 1990S

Cholecystolithiasis: Lithotherapy for the 1990S

Long-term ursodeoxycholic acid therapy is associated with reduced risk of biliary pain and acute cholecystitis in patients with gallbladder stones: A cohort analysis

Effect of dietary phospholipids and their constituents on bile composition in rats and hamsters†

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