Bile Acid Treatment of Cholesterol Gallstones: A Reappraisal

  • Flavio Lirussi
  • Rosa Maria Iemmolo
  • Rocco Orlando
  • Gino Nassuato
  • Maurizio Muraca
  • Mario Strazzabosco
  • Lajos Okolicsányi
Conference paper


The options currently available for the medical treatment of symptomatic cholesterol cholelithiasis, as an alternative to cholecystectomy, include oral administration of chenodeoxycholic acid (CDCA) or ursodeoxycholic acid (UDCA), instillation of methyl-tert-butylether (MTBE) directly into the gallbladder via a percutaneous transhepatic catheter or retrograde endoscopic cannulation (Allen et al. 1985; Thistle et al. 1985), and fragmentation of gallstones by extracorporeal shock waves (Sauerbruch et al. 1986).


Bile Acid Ursodeoxycholic Acid Chenodeoxycholic Acid Cholesterol Gallstone Gallstone Dissolution 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. Allen MJ, Borody TJ, Bugliosi TF, May GR, LaRusso NF, Thistle JL (1985) Rapid dissolution of gallstones by methyl tert-butyl ether. N Engl J Med 312: 217–220PubMedCrossRefGoogle Scholar
  2. Amoruso A, Arnold J, Bettini L, Borel GA, Bretholds A, Capitaine A, Di Simone A, Facchinetti D, Francavilla A, Gonvers JJ, Hofstetter JR, Lanzini A, Muiesan G, Plaitano G, Realini S, Ruggeri G, Sansonno D, Viviani G (1983) A multicenter study on a new repeated-release preparation of ursodeoxycholic acid for gallstones dissolution. Curr Ther Res 33: 565–570Google Scholar
  3. Attili AF, Angélico M, Alvaro D, Capocaccia L (1985) Taurine supplementation during treatment of gallstones with ursodeoxycholic acid. In: Barbara L et al. (eds) Recent advances in bile acid research. Raven Press, New York, pp 313–316Google Scholar
  4. Barbara L for the Progetto Sirmione (1984) Epidemiology of gallstone disease: The Sirmione study. In: Capocaccia L et al. (eds) Epidemiology and prevention of gallstone disease. MTP Press, Lancaster, pp 23–25Google Scholar
  5. Bazzoli F, Morselli Labate AM, Malvolti M, Roda A, Monti F, Rucci P, Roda E (1983) The effect of ursodeoxycholic administration on bile lipid composition in man: comparison of three different ursodeoxycholic preparations. Curr Ther Res 33: 543–550Google Scholar
  6. Bennion LJ, Ginsberg RL, Garnick MB, Bennet PH (1976) Effects of oral contraceptives on the gallbladder bile of normal women. N Engl J Med 294: 189–192PubMedCrossRefGoogle Scholar
  7. Carulli N, Loria P, Medici G, Iori R, Salvioli G (1983) Ursocholic acid (UCA) cholesterol dissolving capacity and effect on bile lipid composition. Gastroenterology 84:1367Google Scholar
  8. Czygan P (1986) Efficacy of combined ursodeoxycholic and chenodeoxycholic acid treatment. Proceedings of the 9th International Bile Acid Meeting, 19–21 October 1986, BaselGoogle Scholar
  9. Dowling RH (1984) Epidemiology and medical treatment of cholesterol gallstones: recurrence, post-dissolution management and the future. In: Capocaccia L et al. (eds) Epidemiology and prevention of gallstone disease. MTP Press, Lancaster, pp 116–128CrossRefGoogle Scholar
  10. Dowling RH, Gleeson D, Hood K, Ruppin DC and the British/Belgian Gallstone Study Group (1986) Gallstone recurrence and post-dissolution management. Proceedings of the 9th International Bile Acid Meeting, 19–21 October 1986, BaselGoogle Scholar
  11. Erlinger S, Le Go A, Husson JM, Fevery J (1984) 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. Hepatology 4: 308–314PubMedCrossRefGoogle Scholar
  12. Fisher NM, Roberts EA, Rosen IE, Shapero TF, Sutherland LR, Davies RS, Bacchus R, Lee SV (1985) The Sunnybrook gallstone study: a double-blind controlled trial of chenodeoxycholic acid for gallstone dissolution. Hepatology 5: 102–107PubMedCrossRefGoogle Scholar
  13. Friedman GD, Kannel WB, Dawber TL (1966) The epidemiology of gallbladder disease: observations in the Framingham study. J Chron Dis 19: 273–292PubMedCrossRefGoogle Scholar
  14. Fromm H, Roat JW, Gonzalez V, Sarva RP, Farivar S (1983) Comparative efficacy and side effects of ursodeoxycholic and chenodeoxycholic acids in dissolving gallstones. Gastroenterology 85: 1257–1264PubMedGoogle Scholar
  15. Gleeson DC, Ruppin DC, Dowling RH (1983) Second look at ursodeoxycholic acid (UDCA): high efficacy for partial but low efficacy for complete gallstone dissolution, and a high rate of acquired stone opacification. Gut 24: A999Google Scholar
  16. Heikel TAJ, Lathe GH (1970) The effects of oral contraceptive sterols on bile secretion and bilirubin Tm in rats. Br J Pharmacol 38: 593–601PubMedGoogle Scholar
  17. Howard P, Gleeson D, Murphy GM, Dowling RH (1984) Ursocholic acid (UCA): bile acid and bile lipid dose-response studies in gallstone (GS) patients. Proceedings of the 8th International Bile Acid Meeting, 1–2 September 1984, BerneGoogle Scholar
  18. Igimi H, Carey MC (1980) Cholesterol monohydrate (C) gallstones dissolve faster in chenode-oxycholate (CDC)-rich bile than in ursodeoxycholate (UDC)-rieh bile. Gastroenterology 78: 1186Google Scholar
  19. Kitani K, Kanai S, Sato Y, Uchida K (1983) The bile flow and biliary excretion of ursocholate in the rat. Life Sci 33: 2377–2386PubMedCrossRefGoogle Scholar
  20. Kupfer RM, Maudgal DP, Northfield TC (1982) Gallstone dissolution rate during chenic acid therapy: effect of bedtime administration plus low cholesterol diet. Dig Dis Sci 27: 1025–1029PubMedCrossRefGoogle Scholar
  21. Lanzini A, Pigozzi G, Facchinetti D, Castellano M, Bettini L, Beschi M, Muiesan G (1986) Ursocholic acid administration to gallstone patients: effect on biliary lipid composition, bile acid pattern and gallstone dissolution. Curr Ther Res 39: 8–18Google Scholar
  22. Leuschner U, Leuschner M, Sieratzki J, Kurtz W, Hubner K (1985) Gallstone dissolution with ursodeoxycholic acid in patients with chronic active hepatitis and two years follow-up. Dig Dis Sci 30: 642–649PubMedCrossRefGoogle Scholar
  23. Lirussi F, Pedrazzoli S, Gerunda G, Orlando R, Venuti M, Nassuato G, Jemmolo RM, Okolicsanyi L (1981) Retained cholesterol intrahepatic bile duct stones: efficacy of high-dose short-term ursodeoxycholic acid administration. Curr Ther Res 30: 775–785Google Scholar
  24. Lirussi F, Iemmolo RM, Piccoli A, Orlando R, Muraca M, Nassuato G, Strazzabosco M, Okolicsanyi L (1986a) Prognostic factors affecting cholesterol gallstone dissolution rate: who will benefit more from medical therapy? Eur J Clin Invest 16: A11CrossRefGoogle Scholar
  25. Lirussi F, Jemmolo RM, Nitti D, Lise M, Sorato R, Corsini A, Okolicsanyi L (1986 b) Medical treatment of cholesterol bile duct stones with ursocholic acid. J Hepatol 3 [Suppl 1]: S141Google Scholar
  26. Loria P, Carulli N, Medici G, Menozzi D, Salvioli G, Bertolotti M, Montanari M (1986) Effect of ursocholic acid on bile lipid secretion and composition. Gastroenterology 90: 865–874PubMedGoogle Scholar
  27. Marks JW, Lan S and the Steering Committee for the National Cooperative Gallstone Study Group (1984) Low-dose chenodiol to prevent gallstone recurrence after dissolution therapy. Ann Intern Med 100: 376–381PubMedGoogle Scholar
  28. Maton PN, Murphy GM, Dowling RH (1977) Ursodeoxycholic acid treatment of gallstones. Dose-response study and possible mechanisms of action. Lancet 2:1297–1301PubMedCrossRefGoogle Scholar
  29. Maton PN, Iser JH, Reuben A, Saxton HM, Murphy GM, Dowling RH (1982) Outcome of chenodeoxycholic acid (CDCA) treatment in 125 patients with radiolucent gallstones. Medicine 61: 86–97PubMedCrossRefGoogle Scholar
  30. Mazzella G, Morselli Labata AM, Malavolti M, Petronelli A, Roda A, Barbara L (1983) The effects of usodeoxycholic administration on bile lipid composition in man: comparison of bed time versus meal time administration. Curr Ther Res 33: 551–557Google Scholar
  31. Northfield TC, Lanzini A, Jazrawi R, Kupfer R, Maudgal DP (1985) Gallstone dissolution rate and recurrence rate during and after bile acid therapy. In: Barbara L et al. (eds) Recent advances in bile acid research. Raven, New York, pp 289–302Google Scholar
  32. Okolicsanyi L, Lirussi F, Pedrazzoli S, Orlando R, Zacchi C, Naccarato R, Nassuato G, Dal Brun G (1982) Intra-and extrahepatic cholesterol cholelithiasis: efficacy of prolonged CDCA administration. Hepatogastroenterology 29:14Google Scholar
  33. Okolicsanyi L, Lirussi F, Strazzabosco M, Iemmolo RM, Orlando R, Nassuato G, Muraca M, Crepaldi G (1986) The effect of drugs on bile flow and composition. An overview. Drugs 31: 430–448Google Scholar
  34. Park YH, Igimi H, Carey MC (1981) Human cholesterol (C) gallstones dissolve as fast in simulated urso-rich bile as in cheno-rich bile. Gastroenterology 81: 1248Google Scholar
  35. Perez-Aguilar F, Breto M, Alfonso V, Martinez-Silvestre M, Berenguer J (1985) Gallstone recurrence following cessation of dissolving treatment and during prophylactic administration of either low-dose chenodeoxycholic acid (CDCA) or medium-dose ursodeoxycholic acid (UDCA). J Hepatol 1: S305Google Scholar
  36. Podda M, Zuin M, de Fazio C, Dioguardi ML, Battezzati PM, Grandinetti G (1986) Efficacy of combined ursodeoxycholic and chenodeoxycholic acid treatment. Proceedings of the 9th International Bile Acid Meeting, 19–21 October 1986, BaselGoogle Scholar
  37. Ponz de Leon M, Carulli N, lori R, Loria P, Smentii A, Zironi F (1980) Medical treatment of radiolucent gallstones with chenodeoxycholic acid (CDCA): follow-up report at four years. Ital J Gastroenterol 12:17–22Google Scholar
  38. Roda E, Bazzoli F, Morselli Labate AM, Mazzella G, Roda A, Sama C, Festi D, Aldini R, Taroni F, Barbara L (1982) Ursodeoxycholic acid vs. chenodeoxycholic acid as cholesterol gallstone-dissolving agents: a comparative randomized study. Hepatology 2: 804–810PubMedCrossRefGoogle Scholar
  39. Ruppin DC, Dowling RH (1982) Is recurrence inevitable after gallstone dissolution by bile acid treatment? Lancet 1: 181–185PubMedCrossRefGoogle Scholar
  40. Salen G, Colalillo A, Verga D, Bagon E, Stephen Tint G, Shefer S (1980) Effect of high and low doses of ursodeoxycholic acid on gallstone dissolution in humans. Gastroenterology 78: 1412–1418PubMedGoogle Scholar
  41. Sama C, Morselli Labate AM, Chiodarelli C, Roda A, Briganti M, Roda E (1983) Bioavailability of a delayed-release preparation of ursodeoxycholic acid in man. Curr Ther Res 33: 558–564Google Scholar
  42. Sauerbruch T, Delius M, Paumgartner G, Holl J, Wess O, Weber W, Hepp W, Brendel W (1986) Fragmentation of gallstones by extracorporeal shock waves. N Engl J Med 314: 818–822PubMedCrossRefGoogle Scholar
  43. Schoenfield LJ, Lachin JM and The Steering Committee of the National Cooperative Gallstone Study Group (1981) Chenodiol (chenodeoxycholic acid) for dissolution of gallstones: the National Cooperative Gallstone Study. Ann Intern Med 95: 257–282PubMedGoogle Scholar
  44. Tamberi P, Alessandrini G, Saccomanno G, Mammoliti F, Cappuccio A, Maccheroni M, Servadio L (1985) Choleretic effect of ursocholic acid in man: its comparison with placebo and ursodeoxycholic acid. Curr Ther Res 38: 50–60Google Scholar
  45. Thistle JL, Lusso NF (1985) Combination of taurine or chenodeoxycholic acid with ursodeoxycholic acid therapy: effects on biliary lipids, bile acids, and gallstones. In: Barbara L et al. (eds) Recent advances in bile acid research. Raven, New York, pp 307–309Google Scholar
  46. Thistle JL, May GL, Allen MJ (1985) Dissolution of gallstones by methyl tert-butyl ether. N Engl J Med 313: 386CrossRefGoogle Scholar
  47. Tokyo Cooperative Study Group (1980) Efficacy and indications of ursodeoxycholic acid treatment for dissolving gallstones. A multicenter double-blind trial. Gastroenterology 78: 542–548Google Scholar
  48. Toulet J, Rousselet J, Viteau JM, Duchon Y, Pagniez R, Samain B, Vienn JL (1983) Relapses and preventive treatment of relapses after dissolution of gallstones in 22 patients. Gastroenterol Clin Biol 7: 605–609PubMedGoogle Scholar
  49. Zuin M, Frigerio G, Ghezzi C, Andreini C, Camissasca M, De Fazio C, Podda M (1984) Effect on biliary lipids of three different preparations containing ursodeoxycholic acid (UDCA): a balanced cross-over study. Curr Ther Res 35: 93–99Google Scholar

Copyright information

© Springer-Verlag Heidelberg 1987

Authors and Affiliations

  • Flavio Lirussi
    • 1
  • Rosa Maria Iemmolo
    • 1
  • Rocco Orlando
    • 1
  • Gino Nassuato
    • 1
  • Maurizio Muraca
    • 1
  • Mario Strazzabosco
    • 1
  • Lajos Okolicsányi
    • 1
  1. 1.Institute of Internal MedicineUniversity of PaduaPaduaItaly

Personalised recommendations