Ursodeoxycholic acid vs. chenodeoxycholic acid as cholesterol gallstone-dissolving agents: A comparative randomized study

Abstract

Cholesterol gallstones are dissolved in man by chenodeoxycholic acid (CDCA) and ursodeoxycholic acid (UDCA). To test the comparative efficacy of these two cholelitholytic bile acids, 223 gallstones patients were randomly treated with either UDCA or CDCA at two different doses: 7 to 8 mg per kg per day and 14 to 15 mg per kg per day. Efficacy and factors influencing dissolution (dose, size of the stones, and time) were evaluated after 3, 6, and 12 months of treatment. UDCA was significantly more efficacious than was CDCA after 3 and 6 months of treatment, whereas after 12 months, no significant differences were observed. UDCA was equally effective at high and low doses, both on small and large stones. CDCA was significantly more effective at high doses and on small stones. Seventy-four per cent of the total dissolutions with UDCA and 42% with CDCA occurred within the first 6 months of treatment. Diarrhea and hypertransaminasemia occurred only in the CDCA-treated patients. We conclude that UDCA seems to be the bile acid of choice in dissolving cholesterol gallstones.

Franco-Belgian Cooperative Study of Ursodeoxycholic Acid in the Medical Dissolution of Gallstones: A Double-Blind, Randomized, Dose-Response Study, and Comparison with Chenodeoxycholic Acid

“…Diarrhea may, therefore, occur under UDCA treatment, although significantly less frequently than with CDCA. This is in agreement with the findings of Roda et al (2). It is important to note that diarrhea occurred, in our study, only (with one exception) in patients treated with the highest doses of UDCA (17 to 19 mg.kg-'-day-'), i.e., doses higher than those usually reported.…”

“…Several studies have suggested that dissolution was more rapid with UDCA than with CDCA (2,6,14,16,17). In our study, a similar trend was observed, since a higher percentage of patients had signs of dissolution at 6 months with UDCA than with CDCA.…”

“…The actuarial dissolution rate at the optimal dose of UDCA was lower in our study than those previously reported (2,14). The reason for this difference is unclear.…”

Gallbladder motility and gallstone formation in obese patients following very low calorie diets. Use it (fat) to lose it (well)

“…19 Up to now, the only proven means of preventing gallstone formation during rapid weight loss induced by VLCDs 43,44 or surgical procedures 45,46 has been the administration of ursodeoxycholic acid, an agent known to reduce biliary cholesterol supersaturation. 47 The present results con®rm our previous ®ndings, 21 as well as those recently published by Gebhard et al 22 showing that modi®cation of VLCD fat content, through an effect on gallbladder emptying, may be an effective alternative. In fact, in the present study, the %E was signi®cantly lower in response to stimulation by the low-fat VLCD test meals with respect to those of the high-fat VLCD, at the initial pre-diet evaluation as well as during the diet; this was also demonstrated by Gebhard et al, 22 albeit with a different study design since these authors compared two liquid meals differing in calories and fat content (2.18 MJ (520 Kcal), 2 g fat/d vs 3.77 MJ (900 kcal), 30 g fat/d).…”

Ursodeoxycholic Acid for the Dissolution of Radiolucent Gall Bladder Stones

“…The optimum dose of UDCA has still to be set tled. Gall-stone dissolution has been var iously stated to be better with smaller doses of UDCA [19], to show no difference through a wide range of doses [3,9,23,27] or with larger doses. Several studies have shown pro gressive reduction in biliary cholesterol satu ration with increasing doses of UDCA through the range 150-1,000 mg daily, or equivalent doses reported as milligrammes per kilogramme body weight [5,13,16,24,26],…”