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[Per oral gallstone dissolution therapy]
1Department of Gastroenterology, Showa University Fujigaoka Hospital.
Nihon Rinsho. Japanese Journal of Clinical Medicine
|July 1, 1993
Summary
Ursodeoxycholic acid (UDCA) and chenodeoxycholic acid (CDCA) can dissolve cholesterol gallstones, but success rates are around 20%. Optimal candidates for bile acid therapy are small, floating, radiolucent gallstones.
Area of Science:
- Gastroenterology and Hepatology
- Pharmacology and Therapeutics
Context:
- Cholesterol gallstone dissolution therapy using bile acids is an established treatment modality.
- Ursodeoxycholic acid (UDCA) and chenodeoxycholic acid (CDCA) are primary agents, differing in their mechanisms of action on bile cholesterol saturation.
Purpose:
- To review the current status and challenges of per oral cholesterol gallstone dissolution therapy.
- To evaluate the efficacy of UDCA treatment over 17 years and explore methods to improve dissolution rates.
Summary:
- Bile acids UDCA and CDCA reduce bile cholesterol output via distinct mechanisms.
- A 17-year clinical review showed UDCA achieved complete dissolution in ~20% and partial dissolution in ~20% of patients.
- Investigated methods like bedtime administration, UDCA/CDCA combination, and UDCA with simvastatin did not significantly improve outcomes over standard UDCA therapy.
Impact:
- Identified key characteristics of gallstones most amenable to bile acid dissolution therapy: small size (<1 cm), Ia ultrasonographic classification, floating on oral cholecystography, and radiolucency.
- This research aids in patient selection for optimizing cholesterol gallstone dissolution therapy outcomes.