Calcification of radiolucent gall stone during treatment with ursodeoxycholic acid.

Bateson, M C; Bouchier, I. A. D.; Trash, D. B.; Maudgal, D P; Northfield, T.C.

doi:10.1136/bmj.283.6292.645

Cited by 77 publications

(11 citation statements)

References 10 publications

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“…They proposed that UDCA may bind calcium ions weakly and increase calcium activity in bile compared to other bile acids. These data well correspond with our present results and may be compatible with the recent reports of gallstone calcification during UDCA therapy (Bateson et al 1981;Raedsch et al 1981;Ros et al 1986). …”

Section: Total and Ionized Calcium Concentrations In Gallbladder Bilesupporting

confidence: 83%

“…Relatively large percentage of smaller bile acid aggregates in UDCA-rich bile may impair its calcium solubility. biliary calcium; bile acid; bile acid micelles; ursodeoxycholic acid It is known that insoluble calcium precipitation in gallbladder bile can act as a nidus for gallstone formation (Been et al 1979;Wosiewitz 1980) and can form calcified shell of cholesterol gallstones (Bateson et al 1981; Schoenfield et al 1981). Such precipitation or calcification of gallstones is clinically important, as it affects successful cholesterol gallstone dissolution.…”

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confidence: 99%

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The Effect of Biliary Bile Acid Concentration and Composition on the Calcium Level in Human Gallbladder Bile.

Tamasawa

Yoneda

Makino

et al. 1993

Tohoku J. Exp. Med.

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Section: Total and Ionized Calcium Concentrations In Gallbladder Bilesupporting

confidence: 83%

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confidence: 99%

The Effect of Biliary Bile Acid Concentration and Composition on the Calcium Level in Human Gallbladder Bile.

Tamasawa

Yoneda

Makino

et al. 1993

Tohoku J. Exp. Med.

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“…Although urso deoxycholic acid does not cause diarrhea and has been proposed to be as effective as CDCA at lower doses [18], it is not certain that this bile acid is superior to CDCA for gallstone dissolution treatment. This is be cause ursodeoxycholic acid is more expen sive than CDCA and recent reports indicate gallstone calcification during ursodeoxy cholic acid treatment is common [19,20].…”

Section: Discussionmentioning

confidence: 99%

Comparison of a Monitored Dose with a Standard Dose of Chenodeoxycholic Acid for Gallstone Dissolution

Mj¹,

Bm²,

Jc³

et al. 1984

Digestion

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The ability of chenodeoxycholic acid to dissolve gallstones was compared using different dosage regimens in two groups of 21 patients. The groups were closely matched for patient factors and stone characteristics known to influence the outcome of dissolution treatment. The patients in one group received a standard dose of chenodeoxycholic acid (15 mg/kg/day) taken at mealtimes. The patients in the second group received a bedtime dose of chenodeoxycholic acid which was sufficient to result in a proportion of this bile acid of 70% in the bile acid pool. This dose was monitored using serum bile acid profiles and varied within this test group (range 5.1–13.9 mg/kg/day). The number of patients whose stones completely dissolved in 12 months was similar in the standard-dose (7 of 21) and monitored-dose (8 of 21) groups. These results suggest that a bedtime dose of chenodeoxycholic acid, which is monitored to produce a level of 70% chenodeoxycholic acid in the biliary bile acid pool, is lower than the standard dose taken after meals but is of comparable efficacy. Lower dosage has the advantage of reducing costs and side effects from the drug, although serum bile acid profiling increases the cost of treatment.

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“…UDCA is generally preferred to CDCA for gallstone dissolution because, in contrast to the latter bile acid (8,9), it does not cause diarrhea and hypertransaminasemia (10). On the other hand, UDCA is more expensive than CDCA and causes acquired gallstone calcification (11)(12)(13) in about 10% of the patients, a dose-related side effect (13).…”

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confidence: 98%

Best-Buy Regimen of Ursodeoxycholic Acid for Patients with Gallstones

Lanzini

Facchinetti

Pigozzi

et al. 1991

Scandinavian Journal of Gastroenterology

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Bedtime administration has been advocated as a strategy for reducing minimum effective dose, side effects, and costs of chenodeoxycholic acid treatment of cholesterol gallstones, but little information is available for ursodeoxycholic acid (UDCA). We prospectively determined the minimum effective dose of bedtime UDCA in 44 patients with radiolucent gallstones treated with a range of UDCA doses (4.6-17.0 mg/kg/day). The average minimum effective dose for reducing the cholesterol saturation index (SI) of gallbladder bile to a value of 0.8 was 8.4 mg/kg/day for bedtime UDCA. The greater potency of the bedtime regimen was confirmed in seven individual patients by comparison with a mealtime regimen. Cholesterol SI was reduced from 1.25 during placebo to 0.73 during 7 mg/kg/day for bedtime UDCA and to 0.81 during 10 mg/kg/day for mealtime UDCA. The effect of the bedtime regimen was not enhanced by a repeated-release tablet formulation of UDCA by comparison with UDCA in 15 patients. We conclude that the bile acid dose is reduced during bedtime UDCA administration by comparison with mealtime UDCA in individual patients and that the best-buy regimen is 8.4 mg/kg/day UDCA given at bedtime for patients with gallstones as a group. With this dose, gallstone dissolution can be supported by unsaturated gallbladder bile at minimum risk of dose-related side effects and at minimum treatment costs.

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Calcification of radiolucent gall stone during treatment with ursodeoxycholic acid.

Cited by 77 publications

References 10 publications

The Effect of Biliary Bile Acid Concentration and Composition on the Calcium Level in Human Gallbladder Bile.

The Effect of Biliary Bile Acid Concentration and Composition on the Calcium Level in Human Gallbladder Bile.

Comparison of a Monitored Dose with a Standard Dose of Chenodeoxycholic Acid for Gallstone Dissolution

Best-Buy Regimen of Ursodeoxycholic Acid for Patients with Gallstones

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