Gallstone dissolution treatment with a combination of chenodeoxycholic and ursodeoxycholic acids

Abstract

Sixteen patients with radiolucent gallstones were treated with a combination of chenodeoxycholic and ursodeoxycholic acids for an average of 19 months. Liver tests remained normal in all patients. In nine of 15 patients (60%), in whom the gallbladder visualized during an oral cholecystogram, gallstones dissolved after one year, in eight of them, partially, and in the remaining one, completely. After two years, partial dissolution became complete in three patients, and partial dissolution occurred in 1 additional patient. Changes in lithogenic index and bile acid pool size were statistically not significant. Biliary content of chenodeoxycholic acid increased significantly from 25.7 +/- 3.53 to 45.2 +/- 3.31 (mean +/- SE)% and that of ursodeoxycholic acid from 2.6 +/- 0.52 to 34.6 +/- 2.45%. There were no discernible changes in serum triglycerides, total cholesterol, and HDL cholesterol. The findings suggest that the chenodeoxycholic-ursodeoxycholic acid combination provides a safe and efficacious treatment for some cholesterol gallstones.

Review article: dissolution of gallstones in the biliary tree

“…Gallstone disease is common and affects between 10 and 20% of the worlds population. Gallstones are classified by their composition into two main groups : cholesterol stones and pigment stones.…”

“…Ursodeoxycholic acid (UDCA) is as effective as CDCA, is free from unwanted effects and a lower dose is required (8)(9)(10)(11)(12)(13) mg kg-' day-'). However, UDCA is more expensive and is reported to cause calcification of some radiolucent stones.'…”

Estimation of Cholesterol Solubilization by a Mixed Micelle Binding Model in Aqueous Tauroursodeoxycholate:Lecithin:Cholesterol Solutions

“…In the Western world, three‐fourths of gallbladder patients have cholesterol (Ch) stones, which contain 80% to 98% Ch by weight 1. For Ch gallstone patients, conjugated ursodeoxycholate (UDC), the 7β‐epimer of chenodeoxycholate (CDC), has been proven to be equal or superior to conjugated CDC in inducing Ch gallstone dissolution when administered orally 2–7. Nevertheless, previous in vitro studies showed that UDC and its conjugates (glycine and taurine) were poor Ch solubilizers relative to CDC and its conjugates 8–10.…”