[Dissolution of gallstones by chenodeoxycholic acid]

Area of Science:

• Hepatology
• Gastroenterology
• Pharmacology

Background:

• Gallstones affect a significant portion of the population.
• Asymptomatic gallstones often require monitoring rather than immediate intervention.
• Chenodeoxycholic acid (CDCA) has been explored for gallstone dissolution therapy.

Purpose of the Study:

• To evaluate the efficacy and safety of chenodeoxycholic acid (CDCA) in dissolving radiolucent gallstones in asymptomatic patients.
• To identify patient and stone characteristics predictive of successful gallstone dissolution with CDCA.

Main Methods:

• A 2-year prospective study involving 34 asymptomatic patients with radiolucent gallstones.
• Patients received chenodeoxycholic acid (CDCA) at a dosage of 750 mg per day.
• Radiological assessment was used to monitor gallstone size and dissolution.
• Adverse events and changes in SGPT levels were recorded.

Main Results:

• 17 out of 34 patients (50%) dropped out before study completion.
• Gallstone dissolution occurred in 5 patients (29%), with 5 additional cases showing decreased size.
• 2 patients (13%) experienced an increase in gallstone size.
• Favorable dissolution criteria included round stones (<1 cm diameter) without edges or fissures.
• Adverse effects like nausea and diarrhea led to treatment discontinuation in 3 cases.
• CDCA treatment resulted in a significant SGPT rise for at least one year.

Conclusions:

• Chenodeoxycholic acid (CDCA) demonstrates only moderate effectiveness for gallstone dissolution.
• Treatment success is limited to a highly selective group of patients with specific gallstone characteristics.
• Potential side effects and drug-induced liver enzyme elevation warrant careful consideration.