Oral dissolution therapy for cholelithiasis: mix and match.

Area of Science:

• Hepatology
• Gastroenterology
• Pharmacology

Background:

• Cholelithiasis (gallstones) affects a significant portion of the population.
• Gallstone dissolution therapy aims to non-invasively treat gallstones.
• Ursodeoxycholic acid (UDCA) is a common treatment, but its efficacy can be limited.

Purpose of the Study:

• To compare the efficacy of combination therapy (chenodeoxycholic acid [CDCA] + UDCA) versus UDCA alone for gallstone dissolution.
• To evaluate dissolution rates based on gallstone size.
• To assess safety and tolerability of the treatment regimens.

Main Methods:

• Prospective, randomized trial involving 120 patients with radiolucent gallstones.
• Patients were assigned to CDCA + UDCA or UDCA alone.
• Gallstone dissolution assessed by oral cholecystography and ultrasonography at 6, 12, and 24 months.

Main Results:

• Combination therapy showed significantly higher complete dissolution rates for small gallstones (≤5 mm) at 6 months (52% vs. 24%).
• Improved dissolution rates for larger stones were observed with combination therapy within 6 months, but this effect diminished over time.
• Stone calcification occurred less frequently with combination therapy, though not statistically significant.

Conclusions:

• Combination therapy with CDCA and UDCA is a preferred treatment for gallstone dissolution due to faster stone clearance.
• This combination may reduce the incidence of stone calcification, potentially lowering long-term treatment costs.
• Both treatment regimens were well-tolerated with minor side effects and no significant changes in serum lipid levels.