title: Ursodeoxycholic acid treatment for patients with postcholecystectomy pain and bile microlithiasis.
abstract: BACKGROUND
  Microlithiasis has been identified as a cause of idiopathic acute pancreatitis in patients with an intact gallbladder. Microlithiasis has also been identified in the bile of some patients who have undergone cholecystectomy. However, it is unknown whether bile microlithiasis causes postcholecystectomy pain.
  
  
  OBJECTIVE
  To identify bile microlithiasis in patients with postcholecystectomy pain and to investigate the therapeutic effect of ursodeoxycholic acid (urso) on such patients with microlithiasis in the bile.
  
  
  METHODS
  Prospective randomized trial.
  
  
  METHODS
  Tertiary medical center.
  
  
  METHODS
  Patients with postcholecystectomy pain and bile crystals.
  
  
  METHODS
  Urso treatment.
  
  
  METHODS
  The severity and frequency of right upper-quadrant abdominal pain were compared with and without urso treatment, and before and after urso treatment.
  
  
  RESULTS
  A total of 118 patients with postcholecystectomy pain were screened for the study. Twelve patients (10%) were identified with bile crystals. In the first phase, 6 of these patients received urso treatment, whereas the other 6 patients did not receive urso treatment. In the second phase, the latter 6 patients were given the urso treatment. After using urso for a few months, their biliary-type abdominal pain significantly improved or resolved. In the control group, there was no improvement in symptoms. There was a significant difference between the 2 groups (P = .01).
  
  
  CONCLUSIONS
  Single-center, small number of patients.
  
  
  CONCLUSIONS
  This study provided evidence that supports the hypothesis that bile microlithiasis is indeed a cause for postcholecystectomy pain. Patients with such postcholecystectomy pain may benefit from a microscopic examination of bile for crystals or microlithiasis, and urso treatment if bile crystals are identified.
authors.affiliation: Division of Digestive Diseases, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia 30322, USA.
authors.forename: Ngozi
authors.initials: N
authors.lastname: Okoro
authors.forename: Amil
authors.initials: A
authors.lastname: Patel
authors.forename: Marney
authors.initials: M
authors.lastname: Goldstein
authors.forename: Naveen
authors.initials: N
authors.lastname: Narahari
authors.forename: Qiang
authors.initials: Q
authors.lastname: Cai
mesh_terms: D000328:Adult; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000379:methods; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects* / Q000379:methods; D042883:Choledocholithiasis / Q000175:diagnosis / Q000188:drug therapy*; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D020347:Lithiasis / Q000737:chemistry; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy*; D011336:Probability; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014580:Ursodeoxycholic Acid / Q000627:therapeutic use*
chemical_list: D014580:Ursodeoxycholic Acid