Ursodeoxycholic acid exerts no beneficial effect in patients with symptomatic gallstones awaiting cholecystectomy

Abstract

Ursodeoxycholic acid (UDCA) and impaired gallbladder motility purportedly reduce biliary pain and acute cholecystitis in patients with gallstones. However, the effect of UDCA in this setting has not been studied prospectively. This issue is important, as in several countries (including the Netherlands) scheduling problems result in long waiting periods for elective cholecystectomy. We conducted a randomized, double-blind, placebo-controlled trial on effects of UDCA in 177 highly symptomatic patients with gallstones scheduled for cholecystectomy. Patients were stratified for colic number in the preceding year (<3: 32 patients; >3: 145 patients). Baseline postprandial gallbladder motility was measured by ultrasound in 126 consenting patients. Twenty-three patients (26%) receiving UDCA and 29 (33%) receiving placebo remained colic-free during the waiting period (89 ؎ 4; median [range]: 75[4-365] days) before cholecystectomy (P ‫؍‬ .3). Number of colics, non-severe biliary pain, and analgesics intake were comparable. A low number of prior colics was associated with a higher likelihood of remaining colic-free (59% vs. 23%, P < .001), without effects on the risk of complications. In patients evaluated for gallbladder motility, 57% were weak and 43% were strong contractors (minimal gallbladder volume > respectively < 6 mL). Likelihood to remain colic-free was comparable in strong and weak contractors (31% vs. 33%). In weak contractors, UDCA decreased likelihood to remain colic-free (21% vs. 47%, P ‫؍‬ .02). In the placebo group, 3 preoperative and 2 postcholecystectomy complications occurred. In contrast, all 4 complications in the UDCA group occurred after cholecystectomy. In conclusion, UDCA does not reduce biliary symptoms in highly symptomatic patients. Early cholecystectomy is warranted in patients with symptomatic gallstones.

Reactive Oxygen Species and the Hypomotility of the Gall Bladder as Targets for the Treatment of Gallstones with Melatonin: A Review

“…UDCA has been reported to reduce the risk of biliary colic [97][98][99][100] by decreasing gall bladder motility. However, recent studies by Vennmann et al [101] involving symptomatic patients with gallstones showed no beneficial effect of UDCA. Also, a 5% increase in the rate of complications was found among the symptomatic patients.…”

Gallstone disease: From genes to evidence-based therapy

“…In about 20% of the cases, a secondary bacterial infection (most commonly by Escherichia coli, Klebsiella, Entercoccus faecalis) occurs [60,61]. After an episode of biliary pain the majority of patients develop repeated biliary symptoms [62]. The incidence of complications in these symptomatic patients is as high as 1-3% per year [58,63].…”

Ursodeoxycholic acid reduces lipid peroxidation and mucin secretagogue activity in gallbladder bile of patients with cholesterol gallstones

“…Indeed, a long-term study on UDCA treatment revealed a significant decrease in the incidence of acute cholecystitis (28). In contrast, a 3-months randomized placebo-controlled study with UDCA showed no beneficial effect on biliary pain or complications of gallstone disease (29). The finding of Guarino et al that UDCA treatment restores gallbladder muscle functions together with a decrease in biochemical markers of oxidative stress and inflammation (14) and the observation that the beneficial effects of UDCA appears to be at least in part independent of gallstone dissolution (28) supports the notion that UDCA mediates an antioxidant and anti-inflammatory effect on the gallbladder wall which, in turn, reduces lithogenicity of bile.…”