title: Ursodeoxycholic acid alone or with chenodeoxycholic acid for dissolution of cholesterol gallstones: a randomized multicentre trial. The British-Italian Gallstone Study group.
abstract: BACKGROUND
  Combination therapy using ursodeoxycholic acid plus chenodeoxycholic acid has been advocated for dissolution of cholesterol gallstones because the two bile acids have complementary effects on biliary lipid metabolism and cholesterol solubilization.
  
  
  OBJECTIVE
  To compare the clinical efficacy of combination therapy with ursodeoxycholic acid monotherapy.
  
  
  METHODS
  A total of 154 symptomatic patients with radiolucent stones (< or = 15 mm) in functioning gallbladders were enrolled from six centres in England and Italy. They were randomized to either a combination of chenodeoxycholic acid plus ursodeoxycholic acid (5 mg.day/kg each) or to ursodeoxycholic acid alone (10 mg.day/kg). Dissolution was assessed by 6-monthly oral cholecystography and ultrasonography for up to 24 months.
  
  
  RESULTS
  Both regimens reduced the frequency of biliary pain and there was no significant difference between them in terms of side-effects or dropout rate. Complete gallstone dissolution on an intention-to-treat basis was similar at all time intervals. At 24 months this was 28% with ursodeoxycholic acid alone and 30% with combination therapy. The mean dissolution rates at 6 and 12 months were 47% and 59% with ursodeoxycholic acid, and 44% and 59% with combination therapy, respectively.
  
  
  CONCLUSIONS
  There is no substantial difference in the efficacy of combined ursodeoxycholic acid and chenodeoxycholic acid and that of ursodeoxycholic acid alone in terms of gallstone dissolution rate, complete gallstone dissolution, or relief of biliary pain.
authors.affiliation: St. George's Hospital, London, UK.
authors.forename: M L
authors.initials: ML
authors.lastname: Petroni
authors.forename: R P
authors.initials: RP
authors.lastname: Jazrawi
authors.forename: P
authors.initials: P
authors.lastname: Pazzi
authors.forename: A
authors.initials: A
authors.lastname: Lanzini
authors.forename: M
authors.initials: M
authors.lastname: Zuin
authors.forename: M G
authors.initials: MG
authors.lastname: Pigozzi
authors.forename: M
authors.initials: M
authors.lastname: Fracchia
authors.forename: G
authors.initials: G
authors.lastname: Galatola
authors.forename: V
authors.initials: V
authors.lastname: Alvisi
authors.forename: K W
authors.initials: KW
authors.lastname: Heaton
authors.forename: M
authors.initials: M
authors.lastname: Podda
authors.forename: T C
authors.initials: TC
authors.lastname: Northfield
mesh_terms: D000328:Adult; D002635:Chenodeoxycholic Acid / Q000008:administration & dosage*; D002769:Cholelithiasis / Q000188:drug therapy*; D002784:Cholesterol / Q000378:metabolism*; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012995:Solubility; D014580:Ursodeoxycholic Acid / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D002635:Chenodeoxycholic Acid; D014580:Ursodeoxycholic Acid; D002784:Cholesterol