Ursodeoxycholic acid vs. chenodeoxycholic acid as cholesterol gallstone-dissolving agents: a comparative randomized...

Area of Science:

• Gastroenterology
• Hepatology
• Pharmacology

Background:

• Cholesterol gallstones are a common ailment.
• Chenodeoxycholic acid (CDCA) and ursodeoxycholic acid (UDCA) are bile acids used to dissolve gallstones.
• Comparative efficacy data between UDCA and CDCA is crucial for treatment selection.

Purpose of the Study:

• To compare the efficacy of UDCA and CDCA in dissolving cholesterol gallstones.
• To evaluate the influence of dose, stone size, and treatment duration on dissolution rates.
• To identify potential side effects associated with each bile acid.

Main Methods:

• A randomized trial involving 223 patients with cholesterol gallstones.
• Patients were treated with either UDCA or CDCA at two dose levels (7-8 mg/kg/day or 14-15 mg/kg/day).
• Efficacy was assessed at 3, 6, and 12 months, considering stone dissolution, dose, size, and time.

Main Results:

• UDCA demonstrated significantly higher efficacy than CDCA at 3 and 6 months.
• After 12 months, no significant difference in efficacy was observed between UDCA and CDCA.
• UDCA was effective at both low and high doses, and on both small and large stones, with 74% of dissolutions occurring within 6 months.
• CDCA was more effective at higher doses and on smaller stones, with 42% of dissolutions occurring within 6 months.
• Diarrhea and hypertransaminasemia were reported only in CDCA-treated patients.

Conclusions:

• UDCA appears to be the preferred bile acid for dissolving cholesterol gallstones due to its faster action and better safety profile.
• Early dissolution rates favor UDCA, particularly within the first six months of treatment.
• CDCA's efficacy is dose-dependent and more pronounced on smaller stones, but it is associated with gastrointestinal side effects.