Ursodeoxycholic acid therapy in gallbladder disease, a story not yet completed

Guarino, Michele Pier Luca; Cocca, Silvia; Altomare, Annamaria; Emerenziani, Sara; Cicala, Michele

doi:10.3748/wjg.v19.i31.5029

Cited by 96 publications

(71 citation statements)

References 45 publications

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“…100 UDCA is prescribed therapeutically for the dissolution of gallstones, recurrent pancreatitis, primary biliary cirrhosis, and primary sclerosing cholangitis (PSC). 101,102 Rodent models even suggest UDCA may be therapeutic in fructose-induced metabolic syndrome. 103 Recently, trials have been underway to determine the efficacy of UDCA to prevent colorectal adenoma recurrence, and results have been mixed.…”

Section: Inactivation Of Ursodeoxycholic Acid By 7b-dehydroxylationmentioning

confidence: 99%

Consequences of bile salt biotransformations by intestinal bacteria

et al. 2016

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Section: Inactivation Of Ursodeoxycholic Acid By 7b-dehydroxylationmentioning

confidence: 99%

Consequences of bile salt biotransformations by intestinal bacteria

et al. 2016

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“…However, UDCA is the most widely used therapeutic agent for treatment of cholestatic hepatopathies 17 18 19 and the reason for this discrepancy is unclear. Interestingly, Akiyama et al also reported that recurrent CBDS was associated with UDCA treatment and suggested that the drug causes stone formation via an unknown mechanism 20.…”

Section: Discussionmentioning

confidence: 99%

Proton pump inhibitor is a risk factor for recurrence of common bile duct stones after endoscopic sphincterotomy – propensity score matching analysis

et al. 2017

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Background and study aims Recurrence of common bile duct stones (CBDS) in patients treated with endoscopic sphincterotomy (ES) can lead to deterioration in their quality of life. Although the pathology and related factors are unclear, we speculated that proton pump inhibiter (PPI) administration increases the risk of CBDS recurrence by altering the bacterial mixture in the bile duct. Patients and methods The primary endpoint of this retrospective study was recurrence-free period. Several independent variables considered to have a relationship with CBDS recurrence including PPI use were analyzed using a COX proportional hazard model, with potential risk factors then evaluated by propensity score matching analysis. Results A total of 219 patients were analyzed, with CBDS recurrence found in 44. Analysis of variables using a COX proportional hazard model demonstrated that use of PPIs and ursodeoxycholic acid (UDCA), as well as the presence of periampullary diverticula (PD) each had a hazard ratio (HR) value greater than 1 (HR 2.2, P = 0.007; HR 2.0, P = 0.02; HR 1.9, P = 0.07; respectively). Furthermore, propensity score matching analysis revealed that the mean recurrence-free period in the oral PPI cohort was significantly shorter as compared with the non-PPI cohort (1613 vs. 2587 days, P = 0.014). In contrast, neither UDCA administration nor PD presence was found to be a significant factor in that analysis (1557 vs. 1654 days, P = 0.508; 1169 vs. 2011 days, P = 0.121; respectively). Conclusion Our results showed that oral PPI administration is a risk factor for CBDS recurrence in patients who undergo ES.

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“…Since the more hydrophilic Ursodeoxycholic acid (UDCA) appeared to be as effective in gallstone dissolution but practically devoid of side-effects, it rapidly replaced CDCA and represents the most widely recorded experience in the literature. 11 UDCA has also been considered to treat patients with biliary sludge. The beneficial effect of UDCA in this condition has been shown in a clinical study in which idiopathic acute pancreatitis has been related to microscopic gallstones or biliary sludge.…”

Section: Editorialmentioning

confidence: 99%

Biliary Sludge: Can we Avoid Punishing Gallbladder by Srivastava Regimen of Integrated Approach of Medicine?

Srivastava¹

2017

JLRDT

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EditorialOpen Access EditorialPrecipitates in the bile have been called by many names like biliary sludge, gallbladder sludge, microlithiasis, and pseudolithiasis. Biliary sludge is best diagnosed by microscopic examination of a fresh sample of gallbladder bile.1 Biochemically, sludge is composed of calcium bilirubinate granules and cholesterol monohydrate crystals embedded in mucus gel. These calcium precipitates, with cholesterol crystals 50µ or more in diameter, produce the characteristic ultrasonic echoes in sludge. The deformable mucin gel accounts for its unique layering and flow characteristics.2 Biliary sludge was first described in 1970's with the advent of ultrasonography and described as lowlevel echoes that layer in the dependent portion of the gallbladder without acoustic shadowing. It is essentially an ultrasonographic diagnosis but sensitivity of only 55% and patients with sludge often have normal test results. Microscopic examination of gallbladder contents is considered the gold standard for the diagnosis of biliary sludge.3 Gallbladder bile can be obtained at the time of endoscopy or by nasogastric tube aspiration of duodenal contents after infusing

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Ursodeoxycholic acid therapy in gallbladder disease, a story not yet completed

Cited by 96 publications

References 45 publications

Consequences of bile salt biotransformations by intestinal bacteria

Consequences of bile salt biotransformations by intestinal bacteria

Proton pump inhibitor is a risk factor for recurrence of common bile duct stones after endoscopic sphincterotomy – propensity score matching analysis

Biliary Sludge: Can we Avoid Punishing Gallbladder by Srivastava Regimen of Integrated Approach of Medicine?

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