title: Is ursodeoxycholic acid detrimental in obstructive cholestasis? A propos of a case of malignant biliary obstruction.
abstract: Ursodeoxycholic acid (UDCA) is the first choice medication for most cholestatic hepatopathies, due to its capability to counteract inflammation and bile-acid-induced liver damage, two common features in cholestasis. However, UDCA is usually contraindicated in obstructive cholestasis, due to the alleged risk of biliary integrity disruption due to its choleretic effect. We report on an 83-year-old man with an unsuspected malignant biliary obstruction who received moderate doses of UDCA (8-12 mg/kg/day) for 5 weeks, because the preliminary evidence suggested he had chemotherapy-induced cholestasis. Liver integrity was extensively protected by UDCA, as indicated by a marked decrease in serum liver enzymes, despite a steady increase in the levels of bilirubin and serum bile acids due to the obstructive process. In conclusion, this report shows, for the first time in humans, that moderate UDCA doses can reduce liver injury associated with complete biliary obstruction. This may contribute to a better understanding of the risk-benefit ratio of the use of UDCA in obstructive cholangiopathies.
authors.affiliation: Gastroenterology and Hepatology Department, Faculty of Medical Sciences, University of Rosario. Rosario, Argentina.
authors.forename: Fernando
authors.initials: F
authors.lastname: Bessone
authors.affiliation: Institute of Experimental Physiology (CONICET-UNR), Faculty of Biochemical and Pharmaceutical Sciences, University of Rosario. Rosario, Argentina.
authors.forename: Marcelo Gabriel
authors.initials: MG
authors.lastname: Roma
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000556:secondary*; D000369:Aged, 80 and over; D002756:Cholagogues and Choleretics / Q000009:adverse effects / Q000627:therapeutic use*; D002760:Cholangiopancreatography, Endoscopic Retrograde / Q000295:instrumentation; D049448:Cholangiopancreatography, Magnetic Resonance; D002779:Cholestasis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000209:etiology; D003110:Colonic Neoplasms / Q000473:pathology*; D006801:Humans; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000150:complications / Q000556:secondary*; D008297:Male; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome; D014580:Ursodeoxycholic Acid / Q000009:adverse effects / Q000627:therapeutic use*
chemical_list: D002756:Cholagogues and Choleretics; D014580:Ursodeoxycholic Acid