Chenotherapy for gallstone dissolution. II. Induced changes in bile composition and gallstone response.

Area of Science:

• Hepatology and Gastroenterology
• Bile Acid Metabolism
• Gallstone Pathophysiology

Background:

• Gallstones affect a significant portion of the population, leading to various complications.
• Bile acid composition plays a crucial role in cholesterol gallstone formation and dissolution.
• Chenodeoxycholic acid is a therapeutic agent used for gallstone dissolution.

Purpose of the Study:

• To investigate the effects of chenodeoxycholic acid and cholic acid on bile saturation and bile acid composition in patients with gallstones.
• To correlate changes in bile composition and chenodeoxycholic acid dosage with gallstone dissolution response.
• To evaluate the predictive value of fasting-state bile analysis for gallstone dissolution.

Main Methods:

• Patients with gallstones received chenodeoxycholic acid, cholic acid, or placebo.
• Bile saturation and biliary bile acid composition were analyzed using gas chromatography and mass spectrometry.
• Dosage, bile acid profiles, and gallstone response were statistically related.

Main Results:

• Chenodeoxycholic acid significantly decreased bile cholesterol saturation by reducing cholesterol proportion.
• Increased biliary chenodeoxycholic acid levels were observed in patients receiving the treatment.
• Gallstone dissolution was generally associated with higher chenodeoxycholic acid dosage and proportion, but exceptions were noted.
• Gallstone type emerged as a major determinant of dissolution, overriding bile composition in many cases.

Conclusions:

• While chenodeoxycholic acid alters bile composition favorably for gallstone dissolution, gallstone type is the primary factor influencing response.
• Fasting-state bile analysis alone has limited predictive value for gallstone dissolution.
• Biliary chenodeoxycholic acid levels can serve as a reliable indicator of patient compliance with treatment.