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Treatment of chronic active hepatitis and primary biliary cirrhosis with ursodeoxycholic acid
S Güldütuna1, U Leuschner, M Imhof
1Abteilung Gastroenterologie, Johann-Wolfgang-Goethe-Universität, Frankfurt am Main.
Insights
Ursodeoxycholic acid (UDCA) benefits liver function in chronic active hepatitis and primary biliary cirrhosis by reducing cholestasis and liver damage. It is safe for long-term use and improves quality of life, particularly in earlier disease stages.
Area of Science:
- Hepatology
- Gastroenterology
- Pharmacology
Background:
- Chronic liver diseases, including chronic active hepatitis (CAH) and primary biliary cirrhosis (PBC), are characterized by cholestasis and hepatocellular damage.
- Ursodeoxycholic acid (UDCA) is a bile acid with potential therapeutic benefits in liver conditions.
Purpose of the Study:
- To evaluate the efficacy of UDCA in improving liver function tests and histology in patients with CAH and PBC.
- To assess the safety and long-term effects of UDCA treatment.
- To elucidate the mechanism of action of UDCA in cholestatic liver diseases.
Main Methods:
- Analysis of liver function tests in patients with CAH and PBC treated with UDCA.
- Review of histological data from controlled trials in PBC patients.
- Assessment of adverse effects and quality of life during long-term UDCA administration.
- In vitro investigations on the protective effects of UDCA on hepatocyte membranes.
Main Results:
- UDCA improved biochemical parameters of cholestasis and hepatocellular damage in CAH and PBC patients.
- Efficacy was more pronounced in earlier stages (I and II) of PBC compared to advanced stages (III and IV).
- Two controlled trials in PBC showed histological improvement, with statistical significance in one study.
- UDCA demonstrated a favorable safety profile with no adverse effects over 10 years, improving quality of life.
Conclusions:
- UDCA is a safe and effective treatment for improving liver function and histology in chronic cholestatic liver diseases like PBC and CAH.
- Its mechanism involves displacing toxic bile salts and protecting hepatocyte membranes.
- UDCA offers significant benefits, especially in early to moderate stages of PBC, and enhances patient quality of life.
Abstract:
Ursodeoxycholic acid (UDCA) improves liver function tests in patients with chronic active hepatitis (CAH) and primary biliary cirrhosis (PBC). UDCA will reduce biochemical parameters of both cholestasis and hepatocellular damage. The effects may be less beneficial in patients with advanced stages of chronic liver disease: in PBC we found the improvement of laboratory parameters in stage I and II very impressive, in stage III and IV it was less marked. Data of two controlled trials in PBC showed an improvement in liver histology, in one study the improvement was statistically significant. UDCA can be administered for at least 10 years without any adverse effects, the treatment is safe and improves life quality. The mode of action of UDCA seems to be in its displacement of toxic hydrophobic bile salts from the bile acid pool and the hepatocellular membrane. In in-vitro investigations a direct protective effect of UDCA on isolated sinusoidal hepatocyte membranes against toxic bile salts has been shown. This protective effect of a more general nature may explain the efficacy of UDCA in different chronic, especially cholestatic liver diseases.