Skip to main content
Gut logoLink to Gut
. 1983 Jul;24(7):609–614. doi: 10.1136/gut.24.7.609

Medical treatment of biliary duct stones: effect of ursodeoxycholic acid administration.

G Salvioli, R Salati, R Lugli, C Zanni
PMCID: PMC1420038  PMID: 6345281

Abstract

Twenty-eight patients with radiolucent biliary duct stones without cholangitis and jaundice were randomly allocated into two treatment groups receiving ursodeoxycholic acid 12 mg/kg (group A) or placebo (group B) in three daily doses for 24 months. In group A stones disappeared completely in seven patients and partially in one; placebo administration had no effect on stone size and three patients of group B (only one of group A) went to surgery for complications. Ursodeoxycholic acid treatment did not adversely affect liver function tests, and alkaline phosphatase decreased. Abdominal and biliary colics also became less frequent in the first six months of therapy in group A, but not in the placebo group. The bile was supersaturated with cholesterol in both groups, but decreased significantly only in patients receiving ursodeoxycholic acid even though the lithogenic index remained high. Cholesterol saturation of bile does not seem to be the only factor determining the dissolution of biliary duct stones which sometimes contain cholesterol as the main component.

Full text

PDF
609

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Admirand W. H., Small D. M. The physicochemical basis of cholesterol gallstone formation in man. J Clin Invest. 1968 May;47(5):1043–1052. doi: 10.1172/JCI105794. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Almond H. R., Vlahcevic Z. R., Bell C. C., Jr, Gregory D. H., Swell L. Bile acid pools, kinetics and biliary lipid composition before and after cholecystectomy. N Engl J Med. 1973 Dec 6;289(23):1213–1216. doi: 10.1056/NEJM197312062892302. [DOI] [PubMed] [Google Scholar]
  3. BARTLETT G. R. Phosphorus assay in column chromatography. J Biol Chem. 1959 Mar;234(3):466–468. [PubMed] [Google Scholar]
  4. Barbara L., Roda E., Roda A., Sama C., Festi D., Mazzella G., Aldini R. The medical treatment of cholesterol gallstones: experience with chenodeoxycholic acid. Digestion. 1976;14(3):209–219. doi: 10.1159/000197933. [DOI] [PubMed] [Google Scholar]
  5. Brühl W. Der Einfluss der Cholezystektomie auf die Lipidzusammensetzung der Lebergalle Nachuntersuchungen an 10 cholezystektomierten Patienten mit Rezidivsteinen in den Gallenwegen. Schweiz Med Wochenschr. 1975 Apr 19;105(16):494–496. [PubMed] [Google Scholar]
  6. Carey M. C. Critical tables for calculating the cholesterol saturation of native bile. J Lipid Res. 1978 Nov;19(8):945–955. [PubMed] [Google Scholar]
  7. Carey M. C., Small D. M. The physical chemistry of cholesterol solubility in bile. Relationship to gallstone formation and dissolution in man. J Clin Invest. 1978 Apr;61(4):998–1026. doi: 10.1172/JCI109025. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Corrigan O. I., Su C. C., Higuchi W. I., Hofmann A. F. Mesophase formation during cholesterol dissolution in ursodeoxycholate-lecithin solutions: new mechanism for gallstone dissolution in humans. J Pharm Sci. 1980 Jul;69(7):869–871. doi: 10.1002/jps.2600690739. [DOI] [PubMed] [Google Scholar]
  9. Danzinger R. G., Hofmann A. F., Schoenfield L. J., Thistle J. L. Dissolution of cholesterol gallstones by chenodeoxycholic acid. N Engl J Med. 1972 Jan 6;286(1):1–8. doi: 10.1056/NEJM197201062860101. [DOI] [PubMed] [Google Scholar]
  10. Dumont M., Erlinger S., Uchman S. Hypercholeresis induced by ursodeoxycholic acid and 7-ketolithocholic acid in the rat: possible role of bicarbonate transport. Gastroenterology. 1980 Jul;79(1):82–89. [PubMed] [Google Scholar]
  11. Fedorowski T., Salen G., Zaki G., Shefer S., Mosbach E. H. Comparative effects of ursodeoxycholic acid and chenodeoxycholic acid in the rhesus monkey. Biochemical and ultrastructural studies. Gastroenterology. 1978 Jan;74(1):75–81. [PubMed] [Google Scholar]
  12. Fromm H., Amin P., Klein H., Kupke I. Use of a simple enzymatic assay for cholesterol analysis in human bile. J Lipid Res. 1980 Feb;21(2):259–261. [PubMed] [Google Scholar]
  13. Glenn F. Silent gallstones. Ann Surg. 1981 Feb;193(2):251–252. doi: 10.1097/00000658-198102000-00022. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. James S. P., Stromeyer F. W., Chang C., Barranger J. A. LIver abnormalities in patients with Gaucher's disease. Gastroenterology. 1981 Jan;80(1):126–133. [PubMed] [Google Scholar]
  15. Kaminski D. L., Barner H. B., Codd J. E., Wolfe B. M. Evaluation of the results of external choledochoduodenostomy for retained, recurrent, or primary common duct stones. Am J Surg. 1979 Feb;137(2):162–166. doi: 10.1016/0002-9610(79)90136-3. [DOI] [PubMed] [Google Scholar]
  16. Kutz K., Miederer S. E., Paumgartner G. Case report: chenodeoxycholic acid therapy of intrahepatic radiolucent gallstones in a patient with Caroli's syndrome. Acta Hepatogastroenterol (Stuttg) 1978 Oct;25(5):398–401. [PubMed] [Google Scholar]
  17. Mack E., Patzer E. M., Crummy A. B., Hofmann A. F., Babayan V. K. Retained biliary tract stones. Nonsurgical treatment with capmul 8210, a new cholesterol gallstone dissolution agent. Arch Surg. 1981 Mar;116(3):341–344. doi: 10.1001/archsurg.1981.01380150059016. [DOI] [PubMed] [Google Scholar]
  18. Makino I., Shinozaki K., Yoshino K., Nakagawa S. [Dissolution of cholesterol gallstones by long-term administration of ursodeoxycholic acid]. Nihon Shokakibyo Gakkai Zasshi. 1975 Jun;72(6):690–702. [PubMed] [Google Scholar]
  19. McDougall R. M., Walker K., Thurston O. G. Prolonged secretion of lithogenic bile after cholecystectomy. Ann Surg. 1975 Aug;182(2):150–153. doi: 10.1097/00000658-197508000-00012. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Salvioli G., Salati R. Faecal bile acid loss and bile acid pool size during short-term treatment with ursodeoxycholic and chenodeoxycholic acid in patients with radiolucent gallstones. Gut. 1979 Aug;20(8):698–704. doi: 10.1136/gut.20.8.698. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Small D. M., Rapo S. Source of abnormal bile in patients with cholesterol gallstones. N Engl J Med. 1970 Jul 9;283(2):53–57. doi: 10.1056/NEJM197007092830201. [DOI] [PubMed] [Google Scholar]
  22. Sonnenshein M., Siegel J. H., Rosenthal W. S., Sable R., Balthazar E. Recurrent choledocholithiasis following cholecystectomy, sphincterotomy and choledochoduodenostomy: successful treatment with chenodeoxycholic acid. Am J Med. 1980 Jul;69(1):163–166. doi: 10.1016/0002-9343(80)90517-3. [DOI] [PubMed] [Google Scholar]
  23. Sue S. O., Taub M., Pearlman B. J., Marks J. W., Bonorris G. G., Schoenfield L. J. Treatment of choledocholithiasis with oral chenodeoxycholic acid. Surgery. 1981 Jul;90(1):32–34. [PubMed] [Google Scholar]
  24. Thistle J. L., Carlson G. L., Hofmann A. F., LaRusso N. F., MacCarty R. L., Flynn G. L., Higuchi W. I., Babayan V. K. Monooctanoin, a dissolution agent for retained cholesterol bile duct stones: physical properties and clinical application. Gastroenterology. 1980 May;78(5 Pt 1):1016–1022. [PubMed] [Google Scholar]
  25. Thistle J. L., Hofmann A. F., Ott B. J., Stephens D. H. Chenotherapy for gallstone dissolution. I. Efficacy and safety. JAMA. 1978 Mar 13;239(11):1041–1046. [PubMed] [Google Scholar]
  26. Trotman B. W. Insights into pigment stone disease. J Lab Clin Med. 1979 Mar;93(3):349–352. [PubMed] [Google Scholar]
  27. Wiegard J., Murphy G. M. Inorganic phosphate in bile and 'bile-rich' duodenal aspirates. Clin Chim Acta. 1978 Oct 2;89(1):169–171. doi: 10.1016/0009-8981(78)90374-1. [DOI] [PubMed] [Google Scholar]

Articles from Gut are provided here courtesy of BMJ Publishing Group

RESOURCES