Drugs Affecting Biliary Lipid Secretion and Gallbladder Motility: Their Potential Role in Gallstone Treatment and Prevention

Abstract

Gallstone disease in the Western world has an estimated prevalence of 10-15% and more than 75% are cholesterol-enriched gallstones. Defective gallbladder motility has been identified as an important pathogenic factor for cholesterol gallstone disease. Various agents may enhance or impair postprandial gallbladder motility, and their effects on interdigestive gallbladder and intestinal motility should also be taken into account. Patients in high-risk situations for gallstone disease, and those chronically treated with drugs inhibiting gallbladder motility (e.g. somatostatin analogues) may benefit from improving gallbladder motility with prokinetic agents. Whether such a strategy can really prevent gallstone formation is still unknown, long-term studies are lacking so far. The efficacy of bile acid therapy with UDCA for gallstone dissolution or for prevention in high risk patients is limited and hampered by high recurrence rates. The efficacy of UDCA in prevention of colics or gallstone related complications in symptomatic patients with gallbladder stones with contraindications for operation or on the waiting list should be explored further, since several retrospective studies showed favourable outcomes with this strategy.

Prophylactic Cholecystectomy in Midgut Carcinoid Patients

“…One patient in our cohort received ursodeoxycholic acid because of gallstone‐related abdominal pain but developed cholecystitis 2 months after initiation of this therapy. With no prospective, randomized trials in somatostatin–analog patients, and with a reported high recurrence rate, ursodeoxycholic acid therapy needs to be investigated further and used only for patients with high operative risk [2, 6, 13, 14].…”

“…Therefore, these analogs have become a cornerstone for the treatment of these patients. However, the treatment may have adverse effects as increased formation of cholesterol-rich crystals in the bile and suppression of cholecystokinin, which may impair gallbladder emptying and inhibit relaxation of sphincter oddi, lead to enhanced gallstone formation [2][3][4][5][6][7]. Although initial studies of somatostatin analogs indicated these effects, no long-term study has confirmed the clinical impact, and recommendations regarding gallbladder surgery in carcinoid patients have been vaguely based.…”

The effects of paramagnetic contrast agents on the gallbladder volume

“…Motilin-analogue erythromycin, intravenous administration of a mixture of essential and non-essential amino acids, cholinomimetic drugs, such as bethanecol and prostigmine, stimulate gallbladder contraction (10,11). Likewise, intravenous injection of nonionic iodinated contrast media or ingestion of water or a dilute solution of contrast medium for various radiological examinations results in the contraction of the gallbladder (2)(3)(4)(5).…”

Association of Oxidative Stress Markers with Cholelithiasis

“…Cholelithiasis is a worldwide disease and it remains to be one of the most common health problems leading to surgical intervention (1,2) . Cholelithiasisis is common with the incidence ranging from (10-20)% of the world population (3) ,the prevalence of cholelitheasis varies considerably within population; the highest known prevalence is among American Indians with up to (60-70) % in females (4) and (10)(11)(12)(13)(14)(15) % in white adults of developed countries (5) .Cholelithiasis is classified as either cholesterol stones (Cs), pigment stones (Ps), or mixed stones (Ms) (6) .These categories of gallstones can be identified according to their predominant chemical composition (7) . Two thirds of individuals with cholelithiasis is asymptomatic (8) .…”