Ursodeoxycholic acid for the prevention of symptomatic gallstone disease after bariatric surgery (UPGRADE): a multicentre, double-blind, randomised, placebo-controlled superiority trial

Haal, Sylke; Guman, Maimoena S S; Boerlage, Thomas C. C.; Acherman, Yair I Z; Brauw, L. M. de; Bruin, Sjoerd C.; Castro, S. M. M. de; Hooft, Jeanin E. van; Laar, Arnold van de; Moes, Daan; Schouten, Manon; Schouten, Ruben; Soest, Ellert J. van; Veen, Ruben N van; Vries, Claire E E de; Fockens, Paul; Dijkgraaf, Marcel G. W.; Gerdes, Victor E. A.; Voermans, Rogier P.

doi:10.1016/s2468-1253(21)00301-0

Cited by 37 publications

(32 citation statements)

References 38 publications

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“…In other words, the effect of UDCA on the occurrence of symptoms in patients with asymptomatic gallstones is unclear. A large RCT revealed that UDCA does not prevent the development of postoperative symptoms in patients with preoperative asymptomatic gallstones (28). Conversely, the results of Della Penna et al showed that UDCA could prevent asymptomatic gallstones from developing symptoms (48).…”

Section: Discussionmentioning

confidence: 99%

“…Only 35 of the remaining 102 articles met the inclusion criteria based on the title and abstract. Next, we carefully read and reviewed the full text of these articles, 17 of which were excluded for various reasons, and 18 of which were finally included in this meta-analysis (23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40). The detailed PRISMA flowchart is shown in Figure 1.…”

Section: Study Selectionmentioning

confidence: 99%

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Effect of ursodeoxycholic acid on gallstone formation after bariatric surgery: An updated meta‐analysis

Ying

Dai

et al. 2022

Obesity

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Objective Bariatric surgery increases the risk of postoperative gallstone formation. Many studies have proposed ursodeoxycholic acid (UDCA) as a preventive agent for postoperative gallstone formation. This study aimed to investigate the effect of UDCA on gallstone formation after bariatric surgery in patients without preoperative gallstones. Methods PubMed, the Web of Science, the Cochrane Library, and EBSCO were searched for articles assessing the effect of UDCA on gallstone formation after bariatric surgery. The outcome was the incidence of postoperative gallstones. Odds ratios were used to assess dichotomous variables, and random‐effects models were used for statistical analyses. Results A total of 18 studies including 4,827 participants met the inclusion criteria. The statistical results showed that the incidence of gallstones in the UDCA group was significantly lower than in the control group. Furthermore, the occurrence of symptomatic gallstones and cholecystectomy was significantly reduced. Conclusions In patients without preoperative gallstones, UDCA can effectively prevent the formation of gallstones after bariatric surgery. In addition, UDCA can significantly reduce the occurrence of symptomatic gallstones and the risk of postoperative cholecystectomy. Doses of 500 to 600 mg/d can be used as a measure to prevent postoperative gallstone formation.

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Section: Discussionmentioning

confidence: 99%

Section: Study Selectionmentioning

confidence: 99%

Effect of ursodeoxycholic acid on gallstone formation after bariatric surgery: An updated meta‐analysis

Ying

Dai

et al. 2022

Obesity

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“…Another placebo‐controlled, double‐blind, randomized controlled trial using conjugated BAs sodium extract (IC‐CBAs) significantly reduced postprandial glucose, fasting insulin, fasting low‐density lipoprotein (LDL), and increased postprandial GLP‐1 levels 153 . In addition, UDCA is commonly used to reduce symptomatic gallstone disease after RYGB 171–173 . At present, this part of the research field is relatively blank, indicating that the research on new delivery system to alleviate and treat obesity and related diseases is still a little‐traveled road.…”

Section: Clinical Application Of Gut Microbiotamentioning

confidence: 99%

“…153 In addition, UDCA is commonly used to reduce symptomatic gallstone disease after RYGB. [171][172][173] At present, this part of the research field is relatively blank, indicating that the research on new delivery system to alleviate and treat obesity and related diseases is still a little-traveled road.…”

Section: Clinical Application Of Gut Microbiotamentioning

confidence: 99%

Gut and obesity/metabolic disease: Focus on microbiota metabolites

Lin

Zhu

2022

MedComm

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Obesity is often associated with the risk of chronic inflammation and other metabolic diseases, such as diabetes, cardiovascular disease, and cancer. The composition and activity of the gut microbiota play an important role in this process, affecting a range of physiological processes, such as nutrient absorption and energy metabolism. The active gut microbiota can produce a large number of physiologically active substances during the process of intestinal metabolism and reproduction, including short‐chain/long‐chain fatty acids, secondary bile acids, and tryptophan metabolites with beneficial effects on metabolism, as well as negative metabolites, including trimethylamine N‐oxide, delta‐valerobetaine, and imidazole propionate. How gut microbiota specifically affect and participate in metabolic and immune activities, especially the metabolites directly produced by gut microbiota, has attracted extensive attention. So far, some animal and human studies have shown that gut microbiota metabolites are correlated with host obesity, energy metabolism, and inflammation. Some pathways and mechanisms are slowly being discovered. Here, we will focus on the important metabolites of gut microbiota (beneficial and negative), and review their roles and mechanisms in obesity and related metabolic diseases, hoping to provide a new perspective for the treatment and remission of obesity and other metabolic diseases from the perspective of metabolites.

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“…Activation of TGR5 by secondary BAs stimulates GLP-1 secretion from L cells to increase insulin secretion and glucose tolerance (61). Evidence shows that modifications of the BA pool presented a beneficial effect in bariatric surgery and antidiabetic treatment (62)(63)(64).…”

Section: Gut Microbiota and Metabolites Altered In T2dmmentioning

confidence: 99%

Effects of Oral Glucose-Lowering Agents on Gut Microbiota and Microbial Metabolites

et al. 2022

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The current research and existing facts indicate that type 2 diabetes mellitus (T2DM) is characterized by gut microbiota dysbiosis and disturbed microbial metabolites. Oral glucose-lowering drugs are reported with pleiotropic beneficial effects, including not only a decrease in glucose level but also weight loss, antihypertension, anti-inflammation, and cardiovascular protection, but the underlying mechanisms are still not clear. Evidence can be found showing that oral glucose-lowering drugs might modify the gut microbiome and thereby alter gastrointestinal metabolites to improve host health. Although the connections among gut microbial communities, microbial metabolites, and T2DM are complex, figuring out how antidiabetic agents shape the gut microbiome is vital for optimizing the treatment, meaningful for the instruction for probiotic therapy and gut microbiota transplantation in T2DM. In this review, we focused on the literatures in gut microbiota and its metabolite profile alterations beneficial from oral antidiabetic drugs, trying to provide implications for future study in the developing field of these drugs, such as combination therapies, pre- and probiotics intervention in T2DM, and subjects with pregestational diabetes and gestational diabetes mellitus.

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Ursodeoxycholic acid for the prevention of symptomatic gallstone disease after bariatric surgery (UPGRADE): a multicentre, double-blind, randomised, placebo-controlled superiority trial

Cited by 37 publications

References 38 publications

Effect of ursodeoxycholic acid on gallstone formation after bariatric surgery: An updated meta‐analysis

Effect of ursodeoxycholic acid on gallstone formation after bariatric surgery: An updated meta‐analysis

Gut and obesity/metabolic disease: Focus on microbiota metabolites

Effects of Oral Glucose-Lowering Agents on Gut Microbiota and Microbial Metabolites

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