Drug and treatment efficacy of chenodeoxycholic acid in 97 patients with cholelithiasis and increased surgical risk

Abstract

Patients with symptomatic cholelithiasis who represent higher than normal surgical risks may be the most suitable candidates for medical dissolution of gallstones. Chenodeoxycholic acid was given to 97 patients in a dosage of 15 mg/kg of body weight per day for a period of two years. Complete gallstone dissolution occurred in 27 of 97 patients (28%). If dropouts are excluded then the success rate is 27 of 64 patients (42%). Diarrhea was a common but manageable side effect for most. Thirty-two percent of patients developed chemical liver test abnormality; however, in only 13% was the degree of abnormality sufficient to require temporary (3%) or permanent (10%) cessation of therapy. Although better chemotherapeutic agents are needed, chenodeoxycholic acid is a reasonable choice for patients with non-calcified cholelithiasis in a functioning gallbladder if the patient is a heightened surgical risk. Because of the prolonged treatment period and the possibility of hepatotoxicity this treatment program requires a substantial commitment on the part of both the patient and the physician.

Adding ursodeoxycholic acid to the endoscopic treatment and common bile duct stenting for large and multiple biliary stones: Will it improve the outcomes?

“…The presence of calcium salts in the gallstones, observed as calcification in CT images, reduces the efficacy of UCDA therapy [14][15][16][17]. However, clinical studies show that if good candidates for medical treatment are selected, up to 60% are completely cleared of CBD stones after 12-24 months of treatment [7,8].…”

“…Although the treatment of choice for cholelithiasis is cholecystectomy, patients with small cholesterol stones, without severe symptoms, and proper function of the gallbladder receive UDCA therapy, if they are not good candidates for surgery. Studies indicate that up to 60% of patients have a chance to completely recover from CBD stones with pharmacotherapies if they are good candidates for medical treatment [7,8].…”

Biliary lipid secretion in man

“…Oral administration of the bile acids CDCA [128][129][130][131][132][133][134][135][136][137][138][139][140][141] and UDCA [142-1551 alone or in combination [146,156,157] is associated with decreased cholesterol SI of gallbladder bile and with cholesterol gallstone dissolution in man. It was originally suggested that bile acids might lower cholesterol SI by expanding [I 581 the reduced bile acid pool size in cholesterol gallstone disease [I 171, thus restoring bile acid secretion to normal.…”

Optimum bile acid treatment for rapid gall stone dissolution.

“…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.…”