Rationale for therapy with ursodeoxycholic acid in patients with cholestatic liver disease

Ursodeoxycholic acid is increasingly used in the treatment of a variety of cholestatic diseases such as primary biliary cirrhosis. The present article summarizes current understanding of the mechanism of action of ursodeoxycholic acid in these diseases. Apart from a direct hepatoprotective effect, ursodeoxycholic acid also influences the enterohepatic circulation with decreased ileal reabsorption and increased faecal excretion of potentially hepatotoxic endogenous bile salts. In addition, a cholehepatic shunt mechanism and immune modulating effects may also be important.