Abstract
Until recently, cholecystectomy was the only treatment for gallstone disease. During the past 15 years, the discovery that gallstone patients have gallbladder bile that is supersaturated with cholesterol has led to the introduction of bile acid therapy aimed at desaturating bile and thus causing gallstone dissolution.
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References
Dissolving hopes for gallstone dissolution (Editorial) (1981). Lancet, 2, 905–906
Isselbacher, K. J. (1981). Chenodiol for gallstones: dissolution or disillusion? (Editorial). Ann. Intern. Med., 95, 377–379
Schoenfield, L. J., Lachin, J. M., The Steering Committee and the National Cooperative Gallstone Study Group (1981). Chenodiol (chenodeoxycholic acid) for dissolution of gallstones: the National Cooperative Gallstone Study. Ann. Intern. Med., 95, 257–282
Mok, H. Y. I., Bell, G. D. and Dowling, R. H. (1974). Effect of differing doses of chenodeoxycholic acid of bile lipid composition and frequency of side effects in patients with gallstones. Lancet, 2, 253–257
Thistle, J. L., Hofmann, A. F., Yu, P. Y. S. et al (1977). Effect of varying doses of chenodeoxycholic acid on bile lipid and biliary bile acid composition in gallstone patients: a dose-response study. Dig. Dis., 22, 1–6
Ruppin, D. C. and Dowling, R. H. (1982). Is recurrence inevitable after gallstone dissolution by bile acid treatment? Lancet, 1, 181–185
Danzinger, R. G., Hofmann, A. F., Schoenfield, L. J. and Thistle, J. L. (1972). Dissolution of cholesterol gallstones by chenodeoxycholic acid. N. Engl.. J. Med., 286, 1–8
Bell, G. D., Whitney, B. and Dowling, R. H. (1972). Gallstone dissolution in man using chenodeoxycholic acid. Lancet, 2, 1213–1216
Makino, I., Hashimoto, H., Shinozaki, K. et al. (1975). Dissolution of cholesterol gallstones by ursodeoxycholic acid. Jap. J. Gastroenterol, 72, 690–702
Kutz, C. and Schulte, A. (1977). Effectiveness of ursodeoxycholic acid in gallstone dissolution. Gastroenterology, 83, 632–633
Maton, P. M., Murphy, G. M. and Dowling, R. H. (1977). Ursodeoxycholic acid treatment of gallstones. Dose-response study and possible mechanism of action. Lancet, 2, 1297–1301
Doran, J., Keighley, M. R. B. and Bell, G. D. (1979). Rowachol — a possible treatment for cholesterol gallstones! Gut, 20, 312–317
Hofmann, A. F., Thistle, J. L., Klein, P. D. et al. (1978). Chenotherapy for gallstone dissolution. II. Induced changes in bile composition and gallstone response. J. Am. Med. Assoc., 239, 1138–1144
Salen, G., Nicolau, G. and Shefer, S. (1973). Chenodeoxycholic acid inhibits elevated hepatic HMG-CoA reductase activity in subjects with gallstones. Clin. Res., 21, 523
Coyne, M. J., Bonnoris, G. G., Goldstein, L. I. and Schoenfield, L. J. (1976). Effect of chenodeoxycholic acid and phenobarbital on the rate-limiting enzymes of hepatic cholesterol and bile acid synthesis in patients with gallstones. J. Lab. Clin. Med., 87, 281–291
Northfield, T. C., LaRusso, N. F., Hofmann, A. F. and Thistle, J. L. (1975). Biliary lipid output during three meals and an overnight fast. II. Effect of chenodeoxycholic acid treatment in gallstone subjects. Gut, 16, 12–17
Hardison, W. G. and Grundy, S. M. (1984). Effect of ursodeoxycholate and its taurine conjugate on bile acid synthesis and cholesterol absorption. Gastroenterology, 87, 130–135
Von Bergmann, K., Epple-Gutsfeld, M. and Leiss, O. (1984). Differences in the effects of chenodeoxycholic and ursodeoxycholic acid on biliary lipid secretion and bile acid synthesis in patients with gallstones. Gastroenterology, 87, 136–143
Corrigan, O. I., Su, C., Higuchi, W. and Hofmann, A. F. (1980). Mesophase formation during cholesterol dissolution in ursodeoxycholic-lecithin solutions: new mechanism for gallstone dissolution in humans. J. Pharmaceut. Sci., 69, 869–871
Ellis, W. R., Bell, G. D. and Clegg, R. J. (1981). Mechanisms for adjuvant cholelitholytic properties of the monoterpene mixture Rowachol. Gastroenterology, 80, 1141
Thistle, J. L. and Hofmann, A. F. (1973). Efficacy and safety of chenodeoxycholic acid for dissolving gallstones. N. Engl. J. Med., 289, 655–659
Bell, G. D., Dowling, R. H., Whitney, B. and Sutor, D. J. (1975). The value of radiology in predicting gallstone type when selecting patients for medical treatment. Gut, 16, 359–364
Wolpers, C. (1976). Auswahl der gallensteintrager zue litholyse. Leber Magen Darm, 6, 43–46
Dolgin, S. M., Schwartz, J. S., Kressel, H. Y. et al (1981). Identification of patients with cholesterol or pigment gallstones by discriminant analysis of radiographic features. N. Engl. J. Med., 304, 808–811
Iser, J. H., Dowling, R. H., Mok, H. Y. I. and Bell, G. D. (1975). Chenodeoxycholic acid treatment of gallstones — a follow-up report and analysis of factors influencing response to therapy. N. Engl. J. Med., 293, 378–383
Maton, P. N., Iser, J. H., Reuben, A. et al (1982). The final outcome of CDCA-treatment in 125 patients with radiolucent gallstones: factors influencing efficacy, withdrawal, symptoms and side effects and post-dissolution recurrence. Medicine, 61, 85–96
Wolpers, C. (1974). Morphologie der gallensteime. Leber Magen Darm, 4, 43–57
Dowling, R. H. (1983). Cholelithiasis: medical treatment. Clin. Gastroenterol, 12, 125–178
Iser, J. H., Maton, P. N., Murphy, G. M. and Dowling, R. H. (1978). Resistance to chenodeoxycholic acid therapy. Treatment in obese patients with gallstones. Br. Med. J., 1, 1509–1512
Dowling, R. H., Ruppin, D. C., Meredith, T., Myszor, M., Forgacs, I. and Murphy, G. M. (1983). Efficacy ofbile acid treatment in dissolving gallstones: colateral benefits of CDCA and UDCA therapy; gallstone recurrence and post-dissolution management. In Paumgartner, G., Stiehl, A. and Gerok, W. (eds.) Bile Acids and Cholesterol in Health and Disease, pp. 345–362. ( Lancaster: MTP Press )
Forgacs, I. C., Maisey, M. N., Murphy, G. M. and Dowling, R. H. (1984). Influence of gallstones and ursodeoxycholic acid therapy on gallbladder emptying. Gastroenterology, 87, 299–307
Ransohoff, D. F. (1985). Natural history of silent gallstones. In Paumgartner, G., Stiehl, A. and Gerok, W. (eds.) Enterohepatic Circulation of Bile Acids and Sterol Metabolism, pp. 277–284. ( Lancaster: MTP Press )
Palmer, A. K. and Heywood, R. (1974). Pathological changes in the rhesus fetus associated with the oral administration of chenodeoxycholic acid. Toxicology, 2, 239–246
Sarva, R. P., Fromm, H., Farivar, S. et al. (1980). Comparison of the effects between ursodeoxycholic and chenodeoxycholic acid on liver function and structure and on bile acid composition in the rhesus monkey. Gastroenterology, 79, 629
Bateson, M. C., Trash, D. B. and Bouchier, I. A. D. (1980). Can a 6-month cholecystogram predict eventual response to gallstone dissolution therapy? Gut, 21, 433 (abstract)
Thomas, P. J. and Hofmann, A. F. (1973). A simple calculation of lithogenic index ofbile. Experimental biliary lipid composition on rectangular coordinates. Gastroenterology, 65, 698–700
Admirand, W. H. and Small, D. M. (1968). The physic-chemical basis of cholesterol gallstone formation in man. J. Clin. Invest., 47, 1045–1052
Hegardt, F. G. and Dam, H. (1971). The solubility of cholesterol in aqueous solution ofbile salts and lecithin. Z. Ernahrungswiss., 10, 223–233
Holzbach, R. T., Marsh, M., Olszewski, M. and Holan, K. (1973). Cholesterol solubility in bile: evidence that supersaturated bile is frequent in healthy man. J. Clin. Invest., 52, 1467–1479
Kupfer, R. M. and Northfield, T. C. (1983). Diurnal variation in cholesterol saturation of gallbladder bile. Gut, 24, 950–953
Kupfer, R. M., Maudgal, D. P. and Northfield, T. C. (1982). Gallstone dissolution rate during chenic acid therapy. Effect of bedtime administration plus low cholesterol diet. Dig. Dis. Sci., 27, 1025–1029
Somerville, K. W., Rose, D. H., Bell, G. D. et al. (1983). Gallstone dissolution and recurrence: are we being misled? Br. Med. J., 284, 1295–1297
Shapero, T. F., Rosem, I. E., Milson, S. R. and Fisher, M. M. (1982). Discrepancy between ultrasound and oral cholecystography in the assessment of gallstone dissolution. Hepatology, 2, 587–590
Tangedahl, T. (1979). Dissolution of gallstones — when and how? Surg. Clin. N. Am., 59, 797–809
Carey, M. C., Park, Y.-H., Igimi, H. and Salvioli, G. (1985). Factors affecting speed of gallstone dissolution during litholytic therapy. In Paumgartner, G., Stiehl, A. and Gerok, W. (eds.) Enterohepatic Circulation of Bile Acid and Sterol Metabolism. ( Lancaster: MTP Press )
Park, Y.-H., Igimi, H. and Carey, M. C. (1982). The ‘mirroring’ of gallstones: description of a novel silvering method to determine the surface area of an irregular object: in vitro demonstration that multiple gallstones from the same gallbladder dissolve in unsaturated ‘bile’ at the same rato. Gastroenterology, 83, 1071–1088
Maudgal, D. P., Kupfer, R. M. and Northfield, T. C. (1983). Factors affecting gallstone dissolution rate during chenic acid therapy. Gut, 24, 7–10
Northfield, T. C., Lanzini, A., Jazrawi, R., Maudgal, D. P. and Kupfer, R. (1985). Methods of improving the efficacy of litholytic therapy. In Paumgartner, G., Stiehl, A. and Gerok, W. (eds.) Enterohepatic Circulation of Bile Acids and Sterol Metabolism, pp. 335–350. ( Lancaster: MTP Press )
Bell, G. D., Sutor, D. J., Whitney, B. and Dowling, R. H. (1972). Factors influencing human gallstone dissolution in monkey, dog and human bile. Gut, 13, A856
Thistle, J. L., LaRusso, N. F., Hofmann, A. F., Turcottle, J., Carlson, G. L. and Ott, B. J. (1982). Differing effects of ursodeoxycholic or chenodeoxycholic acid on biliary cholesterol saturation and bile acid metabolism in man: a dose response study. Dig. Dis. Sci., 27, 161–168
Carey, M. C. and Ko, G. (1979). The importance of total lipid concentration in determining cholesterol solubility in bile and the development of critical tables for calculating % cholesterol saturation with a correction factor for ursodeoxycholate-rich bile. In Paumgartner, G., Stiehl, A. and Gerok, W. (eds.) Biological Effects of Bile Acids. pp. 299–308. ( Lancaster: MTP Press )
Stiehl, A., Raedsch, R., Czygan, P., Gotz, R., Manner, C. H. and Walker, S. (1980). Effects of biliary bile acid composition on biliary cholesterol saturation in gallstone patients treated with chenodeoxycholic acid and/or ursodeoxycholic acid. Gastroenterology, 79, 1192–1198
Barbara, L., Bazzoli, F., Festi, D., Marselli, A. M. L. and Roda, E. (1983). A comparative study of chenodeoxycholic acid and ursodeoxycholic acid as cholesterol gallstone dissolving agents. In Paumgartner, G., Stiehl, A. and Gerok, W. (eds.) Bile Acids and Cholesterol in Health and Disease, pp. 367–370. ( Lancaster: MTP Press )
Roda, E., Bazzoli, F., Labate, A. M. N., Mazzella, G., Roda, A., Sama, C., Festi, D., Aldini, R., Taroni, F. and Barbara, L. (1982). Ursodeoxycholic acid vs chenodeoxycholic acid as cholesterol gallstone-dissolving agents: a comparative randomised study. Hepatology, 2, 804–810
Erlinger, S., Go, A. L., Hussen, J. M. and Fervery, J. (1984). Franco-Belgium co-operative study of ursodeoxycholic acid in the medical dissolution of gallstones: a double blind randomised, dose-response study, and comparison with chenodeoxycholic acid. Hepatology, 4, 308–314
Fromm, H., Roat, J. N., Gonzalev, V., Sarva, R. J. and Farivar, S. (1983). Comparative efficacy and side effects of ursodeoxycholic acid and chenodeoxycholic acid in dissolving gallstones. Gastroenterology, 85, 1257–1264
Maudgal, D. P., Bird, R. and Northfield, T. C. (1979). Optimal timing of doses of chenic acid in patients with gallstones. Br. Med. J., 1, 922–923
Lanzini, A., Facchinetti, D. and Northfield, T. C. (1984). Therapeutic manipulation of the enterohepatic circulation in cholesterol cholelithiasis. Clin. Sci., 66, 11 P
Maudgal, D. P., Kupfer, R. M. and Northfield, T. C. (1982). Minimum effective dose of chenic acid for gallstone patients: reduction with bedtime administration and a low cholesterol diet. Gut, 23, 280–284
Maudgal, D. P., Bird, R., Blackwood, W. S. and Northfield, T.C. (1978). Low cholesterol diet: enhancement of effect of CDCA in patients with gallstones. Br. Med. J., 2, 851–853
Nilsell, K., Angelin, B., Leijd, B. and Einarsson, K. (1983). Comparative effects of ursodeoxycholic acid and chenodeoxycholic acid on bile and kinetics and biliary lipid secretion in humans. Evidence for different modes of action on bile acid synthesis. Gastroenterology, 85, 1248–1256
Ellis, W. R., Bell, G. D., Middleton, B. and White, D. (1981). Adjunct to bile acid treatment for gallstone dissolution: low dose chenodeoxycholic acid combined with terpene preparation. Br. Med. J., 282, 611–612
Bachrach, W. H. and Hofmann, A. K. (1982). Ursodeoxycholic acid in the treatment of cholesterol cholelithiasis: a review. Dig. Dis. Sci., 27, 833–856
Bateson, M. C., Hopwood, D. and Bouchier, I. A. D. (1977). Effect of gallstone dissolution therapy on human liver structure. Am. J. Dig. Dis., 22, 293–299
Bell, G. D., Mok, H. Y. I., Thwe, M. et al. (1974). Liver structure and function in cholelithiasis: effect of chenodeoxycholic acid. Gut, 15, 165–172
Koch, M. M., Giamperi, M. P., Lorenzini, I. et al. (1980). Effect of chenodeoxycholic acid on liver structure and function in man: a serological and biochemical study. Dig. Dis. Sci., 27, 1025–1029
Carey, J. B., Hoflbauer, F. W., Zaxi, F. G. and Nwokolo, C. (1965). Cholelithiasis and hepatic ductular proliferation induced in rats by lithocholic acid (a bile acid occurring naturally in man). Gastroenterology, 48, 809–810
Palmer, R. H. (1969). Toxic effect of lithocholic acid and related 5-H steroids. In Schiff, L., Carey, J. B. and Dietschy, J. M. (eds.) Bile Salt Metabolism, pp. 184–204. ( Illinois: Springfield )
Low-Beer, T. S., Tyor, M. P. and Lack, L. (1969). Effects of sulfation of taurolithocholic acid and glycolithocholic acids on their intestinal transport. Gastroenterology, 56, 721–725
Marks, J. W., Sue, S. O., Pearlman, B. J. et al (1981). Sulfation of lithocholate as a possible modifier of chenodeoxycholic acid-induced elevations of serum transaminase in patients with gallstones. J. Clin. Invest., 68, 1190–1196
Small, D. M. (1971). Gallstone disease — is therapy safe? (Editorial). N. Engl.. J. Med., 284, 214–216
Pedersen, L., Arnfred, T. and Hess-Thaysem, E. (1974). Cholesterol kinetics in patients with cholesterol gallstones before and during chenodeoxycholic acid treatment. Scand. J. Gastroenterol, 9, 787–791
Hoffman, N. E., Hofmann, A. F. and Thistle, J. L. (1974). Effect of bile acid feeding on cholesterol metabolisn in gallstone patients. Mayo Clin. Proc., 49, 236–239
Bell, G. D., Lewis, B., Petrie, A. and Dowling, R. H. (1973). Serum lipids in cholelithiasis: effect of chenodeoxycholic acid therapy. Br. Med. J., 3, 520–523
Bateson, M. C., MacLean, D., Evans, J. R. and Bouchier, I. A. D. (1978). Chenodeoxycholic acid therapy for hypertriglyceridaemia in man. Br. J. Clin. Pharm., 5, 249–254
Albers, J. I., Grundy, J. M., Clearly, P. A. et al. (1982). For the National Co–operative Gallstone Study Group (NCGS): the effect of chenodeoxycholic acid on lipoproteins and apoproteins. Gastroenterology, 82, 638–646
Angelin, B., Einarsson, K., Hellstrom, K. and Leijd, B. (1978). Effects of cholestyramine and chenodeoxycholic acid on the metabolism of endogenous triglyceride in hyper-lipoproteinaemia. J. Lip. Res., 19, 1017–1024
Begemann, F. (1978). Influence of chenodeoxycholic acid on the kinetics of endogenous triglyceride transport in man. Eur. J. Clin. Invest., 8, 283–299
Narisawa, T., Sato, T., Hayakawa, M., Sukuma, A. and Nakano, H. (1971). Carcinoma of the colon and rectum and rats by rectal infusion of MNNG. Gut, 62, 231
Sarwal, A. M., Cohen, B. I. and Raicht, R. F. (1979). Effects of dietary administration of chenodeoxycholic acid on N-methyl-nitrosurea-induced cancer in rats. Biochem. Biophys. Acta., 574, 423
Salvioli, G. and Salati, R. (1979). Faecal bile acid loss and bile acid pool size during short-term treatment with ursodeoxycholic and chenodeoxycholic acid in patients with radiolucent gallstones. Gut, 20, 698
Stiehl, A. (1983). Side-effects of chenodeoxycholic and ursodeoxycholic acid. In Paumgartner, G., Stiehl, A. and Gerok, W. (eds.) Bile Acids and Cholesterol Metabolism in Health and Disease, pp. 387–392. ( Lancaster: MTP Press )
Linos, D. A., Beard, L., O’Fallon, W. M. et al. (1981). Cholecystectomy and carcinoma of the colon. Lancet, 2, 379
Vernick, L. J. and Kuller, L. H. (1971). Cholecystectomy and right-sided colon cancer: an epidemiological study. Lancet, 2, 381
Bateson, M. C., Bouchier, I. A. D., Trash, D. B., Maudgal, D. P. and Northfield, T. C. (1981). Calcification of radiolucent gallstones during treatment with ursodeoxycholic acid. Br. Med. J., 283, 645–6
Igimi, H. and Carey, M. C. (1980). pH-solubility relation of chenodeoxycholic and ursodeoxycholic acids: physical-chemical basis for dissimilar solution and membrane phenomena. J. Lip. Res., 21, 72–89
Hofmann, A. F. (1985). Secretion and precipitation of calcium in bile. In Paumgartner, G., Stiehl, A. and Gerok, W. (eds.) Enterohepatic Circulation of Bile Acids and Sterol Metabolism. pp. 305–19. ( Lancaster: MTP Press )
Cummings, S. A. and Hoffman, A. F. (1984). Physiological determinants of biliary calcium secretion in the dog. Gastroenterology, 87, 664–73
Dumont, M., Erlinger, S. and Uchman, S. (1980). Hypercholeresis induced by ursodeoxycholic acid and 7-ketolithocholic acid in the rat. Possible role of bicarbonate transport. Gastroenterology, 79, 82–9
Iser, J. H., Murphy, G. M. and Dowling, R. H. (1977). Speed of change in biliary lipids and bile acids with chenodeoxycholic acid — is intermittent therapy feasible? Gut, 18, 7–15
Gleeson, D. and Ruppin, D. C. (1985). Discrepancies between cholecystocraphy and ultrasonography in the detection of recurrent gallstones. J. Hepatol, 1, 597–607
Jazrawi, R. P., Joseph, A. E. A., Wilson, A. G. and Northfield, T. C. (1984). Comparison of cholecystography and ultrasonography for detection of gallstones. Gut, 25, A561
Toulet, J., Rousset, J., Viteau, J. M., Douchon, Y. et al. (1983). Recidives et prevention des recidives apres dissolution de la lithiasis vesiculate par lacide chenodeoxyclique chez 22 patients. Gastroenterol. Clin. Biol, 7, 605
Northfield, T. C., Maudgal, D. P., Kupfer, R. M. and Lanzini, A. (1983). Gallstone dissolution and recurrence. In Paumgartner, G., Stiehl, A. and Gerok, W. (eds.) Bile Acids in Health and Disease, pp. 371–9. ( Lancaster: MTP Press )
Lanzini, A., Jazrawi, R. P., Kupfer, R. M., Maudgal, D. P., Joseph, A. E. A. and Northfield, T. C. (1986). Gallstone recurrence after medical dissolution: an overestimated threat? Hepatology. (In press)
Marks, J. W., Lan, S. and the Steering Committee for the NCGS. (1984). Low dose chenodiol for the prevention of gallstone recurrence following dissolution therapy. Arch. Intern. Med., 100, 976–981
Pomare, E. W., Heaton, K. W., Low-Beer, T. S. and Espiner, H. J. (1976). The effect of wheat bran upon bile salt metabolism and upon the lipid composition of bile in gallstone patients. Am. J. Dig. Dis., 21, 521–526
Thornton, J. R., Emmett, P. M. and Heaton, K. W. (1983). Diet and gallstones: effects of refined and unrefined carbohydrate diets on bile cholesterol saturation and bile acid metabolism. Gut, 24, 2–6
Leuschner, M., Leuschner, U., Strohm, W. D., Trube, E., Fuchs, H. and Classen, M. (1984). Radiological and ultrasonographic investigations with respect to patient selection and monitoring for chemical gallstone dissolution. Hepato-gastroenterology, 31, 140–143
Johansson, G. (1984). A prospective study of the clinical significance of the treatment of gallstones with chenodeoxycholic acid. Surg. Gynaecol. Obstet., 159, 127–129
Lalloni, L. and the GREPCO Study (1984). Gallbladder ultrasonography as a diagnostic tool in epidemiological screenings. In Capocaccia et al (eds.) Epidemiology and Prevention of Gallstone Disease, pp. 111–115. ( Lancaster: MTP Press )
Ricci, G. (1986). Prevalence of gallbladder disease (The GREPCO and Sirmione studies). Presented at the 9th International Symposium on Bile Acids, Cortina, Italy, March
Glenn, F., McSherry, C. K. and Dineen, P. (1968). The morbidity of surgical treatment for non malignant biliary tract disease. Surg. Gynaecol. Obstet., 126, 15–26
McSherry, C. K. and Glenn, F. (1980). The incidence and causes of death following surgery for non-malignant biliary tract disease. Ann. Surg., 191, 271–275
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Northfield, T.C., Maudgal, D.P. (1986). Oral Medical Therapy. In: Bateson, M.C. (eds) Gallstone Disease and its Management. Springer, Dordrecht. https://doi.org/10.1007/978-94-009-4173-1_8
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