Franco-Belgian Cooperative Study of Ursodeoxycholic Acid in the Medical Dissolution of Gallstones: A Double-Blind, Randomized, Dose-Response Study, and Comparison with Chenodeoxycholic Acid

Erlinger, S; Go, Alice Le; Husson, Jean-Marc; Fevery, Johan

doi:10.1002/hep.1840040222

Cited by 111 publications

(24 citation statements)

References 21 publications

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“…Therefore, it is likely that UDCA also reduces biliary output of plant sterols and cholestanol. Since UDCA has no effects on lipoprotein metabolism (16,17,28), retained plant sterols in the liver probably lead to higher absolute serum concentrations and their ratios to cholesterol. This led us to consider whether the ratio of cholestanol and plant sterols to cholesterol might be markers of cholesterol secretion into bile.…”

Section: Discussionmentioning

confidence: 99%

Serum plant sterols and biliary cholesterol secretion in humans

Lindenthal

Sudhop

Sartipy

et al. 2002

Journal of Lipid Research

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Ratios of cholestanol, campesterol, and sitosterol to cholesterol in serum are known to reflect cholesterol absorption efficiency. Here, a possible link between these ratios and biliary secretion rates of cholesterol was investigated. Biliary lipid secretion rates and serum sterols were determined in 13 patients with gallstones. Seven were treated with ursodeoxycholic acid (UDCA) (1,000 mg/d). Serum cholesterol and non-cholesterol sterols were also measured in a cross over study in 20 healthy volunteers, who received either placebo or UDCA (750 mg/d). Biliary cholesterol secretion was significantly lower, whereas the non-cholesterol sterols and their ratio to cholesterol were higher in patients with gallstones treated with UDCA. A highly significant negative linear correlation between the ratios of non-cholesterol sterols to cholesterol and biliary cholesterol secretion was observed. In volunteers, administration of UDCA for 4 weeks was followed by a significant increase in non-cholesterol sterols and their ratios. Even 4 weeks after discontinuing UDCA administration, campesterol and sitosterol were still significantly higher than pretreatment levels, which was also true for the campesterolcholesterol ratio after 8 weeks. The results suggest that the ratios of cholestanol, campesterol, and sitosterol to cholesterol can be used as indicators of changes in biliary cholesterol secretion rates. Cholestanol and the two plant sterols campesterol and sitosterol are present in low concentrations in human blood (1, 2), but their concentrations are 400-to 1,000-fold lower than cholesterol (1). The concentrations in serum are the results of synthesis (for cholestanol only), absorption efficiency (campesterol and sitosterol), lipoprotein metabolism, and rate of hepatic excretion into bile (3). They are absorbed from the intestine to a much lesser extent than cholesterol (4, 5). Cholestanol is synthesized in the liver from cholesterol (6), and is almost absent from the diet. Whereas sitosterol is not metabolized to a significant extent in humans (7), a conversion of cholestanol to bile acids has been reported (6). The ratios of cholestanol, campesterol, and sitosterol to cholesterol in serum have been shown to correlate positively with the cholesterol absorption efficiency (2, 8), and have therefore been regarded as markers for changes in the absorption of cholesterol (8-10).Recently it has been reported that treatment with ursodeoxycholic acid (UDCA), a bile acid known to reduce the hepatic secretion of cholesterol (11-14), increases serum concentrations of plant sterols and cholestanol in patients with primary biliary cirrhosis (15) and patients with radiolucent gallstones (16,17). Considering that cholesterol absorption is not affected or even reduced by UDCA (13,14,(18)(19)(20)(21), we thought that these results were not consistent with the observation that the ratio of plant sterols to cholesterol are only markers of cholesterol absorption efficiency. The purpose of the present study was to examine whether the ...

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Section: Discussionmentioning

confidence: 99%

Serum plant sterols and biliary cholesterol secretion in humans

Lindenthal

Sudhop

Sartipy

et al. 2002

Journal of Lipid Research

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“…A rate of 24-38% has been reported for treatment with UDCA alone [54,55]. Although UDCA and CDCA share a common mechanism of action (i.e., increasing the solubility of cholesterol in bile) [56], the safety and efficacy of UDCA are reported to be superior [57,58]. Since CDCA was shown to cause diarrhea at a relatively high frequency and possibly have transient effects on liver dysfunction and serum lipid levels, its use in general clinical practice has decreased [59].…”

Section: Commentarymentioning

confidence: 99%

Evidence-based clinical practice guidelines for cholelithiasis 2016

Tazuma

Unno²,

Igarashi³

et al. 2016

J Gastroenterol

214

178

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Cholelithiasis is one of the commonest diseases in gastroenterology. Remarkable improvements in therapeutic modalities for cholelithiasis and its complications are evident. The Japanese Society of Gastroenterology has revised the evidence-based clinical practice guidelines for cholelithiasis. Forty-three clinical questions, for four categories-epidemiology and pathogenesis, diagnosis, treatments, and prognosis and complications-were selected, and a literature search was performed for the clinical questions with use of the MEDLINE, Cochrane, and Igaku Chuo Zasshi databases for the period between 1983 and June 2012. The guidelines were developed with use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. This article preferentially describes the clinical management of cholelithiasis and its complications. Following description of the diagnosis performed stepwise through imaging modalities, treatments of cholecystolithiasis, choledocholithiasis, and hepatolithiasis are introduced along with a flowchart. Since there have been remarkable improvements in endoscopic treatments and surgical techniques, the guidelines ensure flexibility in choices according to the actual clinical environment. The revised clinical practice guidelines are appropriate for use by clinicians in their daily practice.

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“…First, fecal fatty acid analyses indicate that exogenous bile acids cause a decrease in the proportion of long chain saturated fatty acids in short bowel syndrome patients ( 408 ). Second, administration of cholestyramine to rats causes selective malabsorption of long chain saturated Europe which showed that CDCA had unequivocal efficacy and minimal toxicity ( 424,425 ).…”

Section: Gallstone Dissolution By Oral Bile Acidsmentioning

confidence: 99%

Key discoveries in bile acid chemistry and biology and their clinical applications: history of the last eight decades

Hofmann

Hagey

2014

Journal of Lipid Research

304

284

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conceptions are rare, and provocative judgments stand the test of time. Let us also hope that this effort will be both useful and entertaining. Each of the topics discussed merits at least a full length article, so there will be, of necessity in many instances, consideration of only what we perceive to be the highlights. THE EBB AND FLOW OF MEDICAL INTEREST IN BILE ACIDSAfter the elucidation of the true chemical structure of bile acids in 1932 (see below), there was little interest in bile acids in the Western world. One exception to this statement was the laboratory of Siegfried Thannhauser, who wrote the fi rst textbook of metabolic biochemistry in Germany. He studied cholesterol and bile acid balance in the biliary fi stula dog ( 1 ). During this time, bile acids were sold as liver tonics and laxatives, but there were no placebo-controlled studies showing effi cacy. Indeed, bile acids were considered by the medical profession to have no useful therapeutic properties. The tri-oxo derivative of cholic acid (called "dehydrocholic acid") was known to induce bile fl ow in animals ( 2 ), and was occasionally used to stimulate bile fl ow in patients; but again there were no controlled studies showing effi cacy in hepatobiliary disease.

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Franco-Belgian Cooperative Study of Ursodeoxycholic Acid in the Medical Dissolution of Gallstones: A Double-Blind, Randomized, Dose-Response Study, and Comparison with Chenodeoxycholic Acid

Cited by 111 publications

References 21 publications

Serum plant sterols and biliary cholesterol secretion in humans

Serum plant sterols and biliary cholesterol secretion in humans

Evidence-based clinical practice guidelines for cholelithiasis 2016

Key discoveries in bile acid chemistry and biology and their clinical applications: history of the last eight decades

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