Optimum bile acid treatment for rapid gall stone dissolution.

Jazrawi, R. P.; Pigozzi, Marie Graciella; Galatola, G.; Lanzini, Alberto; Northfield, T.C.

doi:10.1136/gut.33.3.381

Cited by 38 publications

(28 citation statements)

References 36 publications

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“…The optimal dosage and administration regimen of bile acid formulations differ, depending on the published report; for example, UDCA at 7-11.1 mg/kg body weight/day or 600 mg/day after each meal or before bedtime [57,58,63,64]; the UCDA dosage used in Japan is 600 mg/day. If CDCA is used in combination with UDCA, CDCA at 300 mg/day is taken after each meal.…”

Section: Commentarymentioning

confidence: 99%

Evidence-based clinical practice guidelines for cholelithiasis 2016

Tazuma

Unno²,

Igarashi³

et al. 2016

J Gastroenterol

209

178

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Cholelithiasis is one of the commonest diseases in gastroenterology. Remarkable improvements in therapeutic modalities for cholelithiasis and its complications are evident. The Japanese Society of Gastroenterology has revised the evidence-based clinical practice guidelines for cholelithiasis. Forty-three clinical questions, for four categories-epidemiology and pathogenesis, diagnosis, treatments, and prognosis and complications-were selected, and a literature search was performed for the clinical questions with use of the MEDLINE, Cochrane, and Igaku Chuo Zasshi databases for the period between 1983 and June 2012. The guidelines were developed with use of the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system. This article preferentially describes the clinical management of cholelithiasis and its complications. Following description of the diagnosis performed stepwise through imaging modalities, treatments of cholecystolithiasis, choledocholithiasis, and hepatolithiasis are introduced along with a flowchart. Since there have been remarkable improvements in endoscopic treatments and surgical techniques, the guidelines ensure flexibility in choices according to the actual clinical environment. The revised clinical practice guidelines are appropriate for use by clinicians in their daily practice.

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Section: Commentarymentioning

confidence: 99%

Evidence-based clinical practice guidelines for cholelithiasis 2016

Tazuma

Unno²,

Igarashi³

et al. 2016

J Gastroenterol

209

178

View full text Add to dashboard Cite

show abstract

“…For almost 30 years now the therapeutic use of two naturally occurring bile acids chenodeoxycholic (CDCA) and ursodeoxycholic acid (UDCA), have provided an alternative strategy for cholecystectomy [57][58][59][60].…”

Section: Medication For Non-surgical Treatment Of Gallstone Diseasementioning

confidence: 99%

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

vanBerge-Henegouwen¹,

Venneman²,

Erpecum³

et al. 2005

curr drug targets immune endocr metabol disord

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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.

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“…UDCA zeichnet sich durch eine gute Verträglichkeit aus, nur sehr selten wird über eine dosisabhängige Auslösung einer Diarrhö berichtet. Aufgrund des diurnalen Rhythmus der Cholesterin-Sättigung der Galle wird empfohlen, die gesamte Dosis vor dem Schlafengehen einzunehmen [55]. Die Behandlungsdauer bis zur Steinauflösung beträgt in Abhängigkeit von der Steingröße -bei zirka 1 mm Größenabnahme pro Monat -meist 6-24 Monate [56].…”

Section: Symptomatische Cholezystolithiasisunclassified

Cholezystolithiasis – ein Wandel im interdisziplinären Vorgehen?

2006

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Cholecystolithiasis has an enormous clinical and socioeconomic impact due to its high prevalence and the risk to develop severe complications. 80% of persons with gallstones are asymptomatic at the time of diagnosis. After a first episode of biliary symptoms, about 70% of patients will experience recurrent biliary symptoms within 2 years, and 1-2% per year will develop biliary complications. The diagnosis of gallstone disease is made on the basis of the patient's history, a physical examination, an abdominal ultrasound, and laboratory tests to exclude complications such as cholecystitis, cholangitis, choledocholithiasis, and pancreatitis. Asymptomatic cholecystolithiasis is usually not treated. Exceptions are a porcelain gallbladder, simultaneous gallbladder polyps ‡ 10 mm, and gallstones > 3 cm due to the enhanced risk to develop gallbladder carcinoma. In addition, prophylactic cholecystectomy may be considered in asymptomatic patients undergoing heart transplantation or surgery for morbid obesity. Laparoscopic cholecystectomy represents the first-line treatment of symptomatic cholecystolithiasis. Nonsurgical treatment with ursodeoxycholic acid should only be considered in patients with small (£ 5(-10) mm), mildly symptomatic gallbladder stones in a functioning gallbladder when surgery is refused by the patient, surgical risk is high, or surgery is impossible. Extracorporeal shock wave lithotripsy of gallbladder stones is not recommended any more considering recurrence rates of 50-80% after 10 years.

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Optimum bile acid treatment for rapid gall stone dissolution.

Cited by 38 publications

References 36 publications

Evidence-based clinical practice guidelines for cholelithiasis 2016

Evidence-based clinical practice guidelines for cholelithiasis 2016

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

Cholezystolithiasis – ein Wandel im interdisziplinären Vorgehen?

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