Ursodeoxycholic Acid for the Dissolution of Radiolucent Gall Bladder Stones

Neligan, P.; Bateson, M C; Trash, D. B.; Ross, P. E.; Bouchier, I. A. D.

doi:10.1159/000198992

Cited by 14 publications

(5 citation statements)

References 13 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%

“…The next set of selection criteria may be called optimal; it includes radiolucent gallstones with diameters of 10 mm or less in a functioning gallbladder and in nonobese patients. The effectiveness of BAT in these patients can be deduced from several case series (121,124,129,135). One of the best case series of this type is that by Podda et al (124), because of the number of patients treated and the results obtained.…”

Section: Trem'ment Of Symptomatic Cholelithiasismentioning

confidence: 99%

“…In a recent series of 126 patients treated with ursodeoxycholic acid (8 to 10 *day), cystic duct obstruction developed in about 10% of patients after 4 yr of treatment and cholecystectomy was performed in 17% of the patients within 18 mo of treatment because of recurrent pain, acute cholecystitis or pancreatitis (126). However, the controlled trial by the National Cooperative Gallstone Study Group seems to indicate that the incidence of such events after BAT is not different from that in a matched control group (119).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 ( are strictly limited to superoptimal criteria; thus data for such patients must be gathered from several sources (119-121,124).…”

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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%

Section: Trem'ment Of Symptomatic Cholelithiasismentioning

confidence: 99%

mentioning

confidence: 99%

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Cholecystolithiasis: Lithotherapy for the 1990S

Strasberg

Clavien

1992

Hepatology

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“…Bile acid therapy is an attractively safe option but is suitable for only a few patients and is unsuitable in those with severe recurrent symptoms 20. The gall bladder must be functioning, and this can be best be shown by an oral cholecystogram.…”

Section: Treatmentmentioning

confidence: 99%