Is recurrence inevitable after gallstone dissolution by bile-acid treatment?
Gallstone dissolution was observed on 60 occasions in 54 patients; in 6, recurrent stones were dissolved by a second course of medical treatment. When complete gallstone dissolution was confirmed (by two consecutive cholecystograms, 3 months apart) bile-acid treatment was stopped, and the patients were followed for up to 71/2 years with oral cholecystograms taken annually (or sooner if symptoms suggested early recurrence). Recurrence was detected 30 times after the 60 episode of gallstone dissolution (50%), in 25 of the 54 patients (46%), and in 25 of 46 patients who had had at least one post-dissolution X-ray before recurrence (54%). In 21 of these 25 patients (84%) the recurrence was observed within 2 years of treatment being stopped. There were no significant differences in clinical details and pre-treatment gallstone characteristics between the 25 gallstone-recurrent (at any time) and the 29 gallstone-free (at the time of study) patients, nor between a subgroup of patients in whom recurrent stones developed rapidly (less than or equal to 1 year) and a subgroup who remained gallstone-free for 3 years. It is concluded that long-term follow-up is advisable and that post-dissolution treatment will be necessary to prevent gallstone recurrence.
D000328:Adult; D000368:Aged; D001647:Bile Acids and Salts / Q000378:metabolism; D002635:Chenodeoxycholic Acid / Q000627:therapeutic use*; D002769:Cholelithiasis / Q000188:drug therapy* / Q000601:surgery; D002784:Cholesterol / Q000378:metabolism; D003840:Deoxycholic Acid / Q000031:analogs & derivatives*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012737:Sex Factors; D012995:Solubility; D013997:Time Factors; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use*
D001647:Bile Acids and Salts; D003840:Deoxycholic Acid; D002635:Chenodeoxycholic Acid; D014580:Ursodeoxycholic Acid; D002784:Cholesterol