Low-dose ursodeoxycholic acid prolongs cholesterol nucleation time in gallbladder bile of patients with cholesterol gallstones.
The high rate of stone recurrence represents a drawback of non-surgical therapy of cholesterol gallstone disease. Although most studies report that long-term bile acid treatment does not have protective effects, preliminary results suggest that low-dose ursodeoxycholic acid decreases the rate of gallstone recurrence in a subgroup of younger patients. To clarify the underlying mechanism we investigated whether low-dose ursodeoxycholic acid treatment influences biliary cholesterol saturation and/or nucleation time of cholesterol. Ten patients with cholesterol gallstones and functioning gallbladder received 250 mg ursodeoxycholic acid/day at bedtime 6-10 days prior to cholecystectomy. Eleven patients with cholesterol gallstones without treatment served as controls. Cholesterol crystals were present in the gallbladder bile of 7 out of the 10 patients receiving ursodeoxycholic acid and in all control biles. Ursodeoxycholic acid treatment significantly (P less than 0.02) decreased the cholesterol saturation index (mean +/- S.E.: 0.94 +/- 0.05 vs. 1.43 +/- 0.18) and led to an approximately 5-fold prolongation (P less than 0.005) of the cholesterol nucleation time (mean +/- S.E.: 12.0 +/- 2.4 vs. 2.3 +/- 0.7 days). We conclude that low-dose ursodeoxycholic acid might be effective in the prevention of post-dissolution gallstone recurrence by both decreasing cholesterol saturation and prolonging cholesterol nucleation time.
Jüngst
D
D
Department of Internal Medicine II, Klinikum Grosshadern, University of Munich, F.R.G.
Brenner
G
G
Pratschke
E
E
Paumgartner
G
G
D000328:Adult; D000368:Aged; D001646:Bile / Q000378:metabolism*; D001647:Bile Acids and Salts / Q000378:metabolism; D002769:Cholelithiasis / Q000378:metabolism* / Q000517:prevention & control; D002784:Cholesterol / Q000378:metabolism*; D003460:Crystallization; D003840:Deoxycholic Acid / Q000031:analogs & derivatives*; D004334:Drug Administration Schedule; D005260:Female; D005704:Gallbladder / Q000378:metabolism*; D006801:Humans; D050356:Lipid Metabolism; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014580:Ursodeoxycholic Acid / Q000008:administration & dosage* / Q000627:therapeutic use
D001647:Bile Acids and Salts; D003840:Deoxycholic Acid; D014580:Ursodeoxycholic Acid; D002784:Cholesterol