Retrospective comparison of 'Cheno' and 'Urso' in the medical treatment of gallstones.

Abstract

SUMMARY In two groups of gallstone patients ideally suited for medical treatment, the effect of six to 18 months' therapy was compared retrospectively in 52 given chenodeoxycholic acid (CDCA) and 46 given ursodeoxycholic acid (UDCA). The minimum dose (mg kg-1day-1) 18 months' treatment with CDCA and UDCA in diminishing the saturation of bile with cholesterol and in dissolving gallstones. We also compared the frequency and severity of symptons (such as biliary colic and non-specific dyspepsia) and the incidence of side-effects, before and during treatment. This paper reports our findings. Methods PATIENTSFifty-two patients treated with CDCA and 46 treated with UDCA fulfilled the criteria listed above and were selected for the comparative study. Details of their ages, sex ratios, and body weights are summarised in Table 1. There were no significant differences between the groups for any of these

Ursodeoxycholic acid exerts no beneficial effect in patients with symptomatic gallstones awaiting cholecystectomy†‡§

“…Different findings in the present and previous studies [1][2][3][4] may be explained by differences in study design, patient selection, or treatment length and intensity. In the non-randomized study by Tomida et al, 4 527 patients referred for symptomatic or asymptomatic gallbladder stones were offered treatment with 600 mg UDCA per day.…”

“…[16][17][18][19] Also, in these studies a high percentage of patients suffer from episodes of intercurrent biliary colics and complications. Furthermore, UDCA has been reported to reduce risk of biliary colics [1][2][3][4] and complications as pancreatitis. 5,6 Although these studies were not randomized and placebo-controlled, UDCA is often used in symptomatic gallstone patients refusing cholecystectomy or with contraindications for surgery.…”

“…1. Patients became eligible on admission to the waiting list for elective cholecystectomy for symptomatic cholecystolithiasis, defined as: (1) presence of gallbladder stones (presence of highly reflective echoes from the anterior surface of a entity in the gallbladder, which is mobile on repositioning the patient and shows marked posterior acoustic shadowing) or sludge (defined by presence of low-level echoes that layer in the dependent portion of the gallbladder without acoustic shadowing on ultrasonography), without bile duct stones or bile duct dilatation at ultrasonography; (2) at least one episode of severe right upper quadrant or midline epigastric pain of at least 30 minutes duration, with radiation or need to move, or at least three episodes of severe right upper quadrant or midline epigastric pain of at least 30 minutes duration without such radiation or need to move, in the previous 12 months; (3) no significant clinical suspicion of bile duct stones (e.g., disturbed liver biochemistry). Sixty-three of the referred patients did not meet these eligibility criteria.…”

“…We chose to treat patients according a fixeddose regimen of UDCA of 750 mg (9-10 mg/kg for most patients, Table 1), similar to dosages previously used for gallstone dissolution treatments and prevention of biliary colic or recurrent pancreatitis. 1,[3][4][5] Patients took the first dosage at the day of inclusion and the last dosage the night before cholecystectomy. Patients were evaluated at baseline, and for primary or secondary endpoints (see below) by one of the trial physicians (N.G.V., M.G.H.B., and Y.C.A.K.)…”

“…Ursodeoxycholic acid (UDCA) has been claimed to reduce the risk of biliary pain, regardless of gallstone dissolution. [1][2][3][4] Also, biliary pancreatitis might be prevented by UDCA treatment. 5,6 Proposed underlying mechanisms for these beneficial effects are impaired gallbladder motility with increased fasting and residual postprandial gallbladder volumes, 7,8 less cholesterol crystals, 9 or decreased mucin contents in bile 10 during UDCA treatment.…”