Abstract
Chemical dissolution of cholesterol gallstones using ursodeoxycholic acid (UDCA) in six patients with histologically confirmed HBsAg-negative chronic active hepatitis was started after a minimum of one year of therapy with steroids, azathioprine, or chloroquine and a treatment-free period of 8–15 months. The treatment with UDCA lasted 3–20 months with a daily dose of 8–11 mg/kg. Four patients served as controls. A decrease in transaminases (P<0.05) occurred in all patients during the UDCA therapy. After completion of the treatment, the figures rose again, but did not return to the initial value. The stones dissolved in five patients. A second liver biopsy was carried out in two patients after UDCA therapy, and this showed no detectable deterioration. Four patients refused biopsy because the laboratory parameters had improved under UDCA. A stone recurred in one patient six months after the end of therapy; the others have remained free of stones for up to 24 months.
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Danzinger RG, Hofmann AF, Schoenfield LJ, Thistle JL: Dissolution of cholesterol gallstones by chenodeoxycholic acid. N Engl J Med 286:1–8, 1972
Makino I, Shinozaki K, Yoshino K, Nakagawa S: Dissolution of cholesterol gallstones by ursodeoxycholic acid. Jpn J Gastroenterol 72:690–702, 1975
Leuschner U, Reber E, Erb W: Treatment of patients with gallstones with chenodeoxycholic acid. Dtsch Med Wochenschr 102:156–160, 1977
Leuschner U, Leuschner M, Hübner K: Gallstone dissolution in patients with chronic active hepatitis. Gastroenterology 80:1834, 1981 (abstract)
Poupon RE, Poupon RY, Petit D, Infante R, Darnis F: Acides biliares sériques et disparition de l'acide cholique au cours des maladies du foie d'origine alcoolique. Gastroenterol Clin Biol 2:475–480, 1978
Zahor Z, Sternby NH, Kagan Z, Uemura K, Vanecek R, Vichert AM: Frequency of cholelithiasis in Prague and Malmö. An autopsy study. Scand J Gastroenterol 9:3–7, 1974
Lindström CG: Frequency of gallstone disease in a well-defined Swedish population. A prospective necropsy study in Malmö. Scand J Gastroenterol 12:341–346, 1977
Sampliner RE, Bennet PH, Comess LJ, Rose FA, Burch TA: Gallbladder disease in Pima Indians. Demonstration of high prevalence and early onset by cholecystography. N Engl J Med 238:1358–1364, 1970
Gracie WA, Ransohoff DF: The natural history of silent gallstones. The innocent gallstone is not a myth. N Engl J Med 307:798–800, 1982
Lund J: Surgical indications in cholelithiasis: Prophylactic cholecystectomy elucidated on the basis of long-term follow-up on 526 nonoperated cases. Ann Surg 151:153–162, 1960
Wenckert A, Robertson B: The natural course of gallstone disease: Eleven-year review of 781 nonoperated cases. Gastroenterology 50:376–381, 1966
Maudgal DP, Joseph AEA, Wansbrough-Jones MH: Gallbladder abnormalities in acute hepatitis: A prospective study. Gut 23:A910, 1982 (abstract)
Selmair H, Schmidt DS: Die Häufigkeit von Gallenblasenkomplikationen bei chronisch-entzündlichen Lebererkrankungen. Z Gastroenterol 9:79–86, 1971
Hess W: Die Anzeigenstellungen zu den operativen Eingriffen an Gallenwegen und Pankreas. Internist 5:457–464, 1964
Eder H: Zur Chirurgie der extrahepatischen Gallenwege bei Steinerkrankungen. Zbl Chir 95:1039–1046, 1970
McSherry CK, Glenn F: The incidence and causes of death following surgery for nonmalignant biliary tract disease. Ann Surg 191:271–275, 1980
Aranha GV, Sontag SJ, Greenlee HB: Cholecystectomy in cirrhotic patients: A formidable operation. Am J Surg 143:55–59, 1982
Bateson MC, Hopwood D, Bouchier IAD: Effect of gallstone dissolution therapy on human liver structure. Am J Dig Dis 22:293–299, 1977
Fromm H, Holz-Slomczyk M, Zobl H, Schmidt E, Schmidt FW: Studies of liver function and structure in patients with gallstones before and during treatment with chenodeoxycholic acid. Acta Hepato-Gastroenterol 22:359–369, 1975
Iser JH, Isaacs PET, Dowling RH: Absence of hepatotoxicity in gallstone patients after long-term chenodeoxycholic acid (CDCA) therapy. Aust NZ J Med 7:564–567, 1977
Ono T, Ohto M, Kawamura K, Saisho H, Tsuchiya Y, Kimura K, Yogi Y, Karasawa E: Chenodeoxycholic acid therapy for the dissolution of gallstones. Its efficacy and safety. Jpn J Gastroenterol 73:1232–1246, 1976
Fisher RL, Anderson DW, Boyer JL, Ishak K, Klatskin G, Lachin F, Phillips MJ: A prospective morphologic evaluation of hepatic toxicity of chenodeoxycholic acid in patients with cholelithiasis: The National Cooperative Gallstone Study. Hepatology 2:187–201, 1982
Miyai K, Price VM, Fisher MM: Bile acid metabolism in mammals. Ultrastructural studies on intrahepatic cholestasis induced by lithocholic and chenodeoxycholic acids in the rat. Lab Invest 24:292–302, 1971
Fisher MM, Magnusson R, Miyai K: Bile acid metabolism in mammals. I. Bile acid induced intrahepatic cholestasis. Lab Invest 21:88–91, 1971
Leuschner U, Schneider M, Loos R, Kurtz W: Morphologic investigations on the toxicity of orally applied CDCA in the liver, gastrointestinal tract, kidney and adrenal gland of the rat. Res Exp Med 171:41–55, 1977
Leuschner U, Schneider M, Korte L: The influence of chenodeoxycholic acid and ursodeoxycholic acid on the hepatic structure of the rat. Z Gastroenterol 17:244–255, 1979
Dyrszka H, Chen T, Salen G, Mosbach EH: Toxicity of chenodeoxycholic acid in the rhesus monkey. Gastroenterology 69:333–337, 1975
Palmer AK, Heywood R: Pathological changes in the rhesus fetus associated with the oral administration of chenodeoxycholic acid. Toxicology 2:239–246, 1974
Webster KH, Lancaster MC, Wease DF: The effect of primary bile acid feeding on cholesterol metabolism and hepatic function and morphology in the rhesus monkey. Gastroenterology 65:A-52/576, 1973
Morrissey KP, McSherry CK, Swarm RL, Niemann WH, Deitrick JE: Toxicity of chenodeoxycholic acid in the nonhuman primate. Surgery 77:851–860, 1975
Sarva RP, Fromm H, Farivar S, Sembrat RF, Mendelow H, Shinozuka H, Wolfson SK: Comparison of the effects between ursodeoxycholic and chenodeoxycholic acids on liver function and structure and on bile acid composition in the rhesus monkey. Gastroenterology 79:629–636, 1980
Gadacz TR, Allan RN, Mack E, Hofmann AF: Impaired lithocholate sulfation in the rhesus monkey: A possible mechanism for chenodeoxycholate toxicity. Gastroenterology 70:1125–1129, 1976
Stiehl A, Raedsch R, Kommerell B: Increased sulfation of lithocholate in patients with cholesterol gallstones during chenodeoxycholate treatment. Digestion 12:105–110, 1975
Palmer PH, Bolt MG: Bile acid sulfation. I. Synthesis of lithocholic acid sulfates and their identification in human bile. J Lipid Res 12:671–679, 1971
Fromm H, Roat JW, Gonzales V, Sarva RP, Farivar S: Comparative efficacy and side effects of ursodeoxycholic and chenodeoxycholic acids in dissolving gallstones. A double-blind controlled study. Gastroenterology 85: 1257–1264, 1983
Celle G, Cavanna M, Bocchini R, Robbiano L, Dodero M, Volpi C, Dellepiane F, Cuneo-Crovari P, Scarvaglieri-Guiliano R, Sigari-Canu G: Chenodeoxycholic acid (CDCA) versus ursodeoxycholic acid (UDCA): A comparison of their effects in pregnant rats. Arch Int Pharmacodyn 246:146–158, 1980
Takahashi H, Tozuka K, Miyashita T, Miyamoto K: Chronic toxicity studies of ursodeoxycholic acid orally administered for six months in Wistar male rat. Kiso to Rinsho (Clin Rep) 9:3209–3222, 1975
Takahashi H, Tozuka K, Miyashita T, Usui K, Miyamato K: Subacute toxicity studies of orally administered ursodeoxycholic acid in Wistar rat. Kiso to Rinsho (Clin Rep) 9:3167–3181, 1975
Miyai K, Javitt NB, Gochman N, Jones HM, Baker D: Hepatotoxicity of bile acids in rabbits. Ursodeoxycholic acid is less toxic than chenodeoxycholic acid. Lab Invest 46:428–437, 1982
Fedorowski T, Salen G, Colallilo A, Tint GS, Mosbach EH, Hall JC: Metabolism of ursodeoxycholic acid in man. Gastroenterology 73:1131–1137, 1977
Makino I, Nakagawa S: Changes in biliary lipid and biliary bile acid composition in patients after administration of ursodeoxycholic acid. J Lipid Res 19:723–728, 1979
Salvioli G, Salati R: Fecal bile acid loss and bile acid pool size during short-term treatment with ursodeoxycholic and chenodeoxycholic acid in patients with radiolucent gallstones. Gut 20:698–704, 1979
Bazzoli F, Fromm H, Sembrat RF, Sarva RP, Ceryak S: Comparative formation of lithocholic acid from chenodeoxycholic and ursodeoxycholic acids in the colon. Gastroenterology 83:753–760, 1982
Thistle JL, La Russo NF, Hofmann AF, Turcotte J, Carlson GL, Ott BJ: Differing effects of ursodeoxycholic or chenodeoxycholic acid on biliary cholesterol saturation and bile acid metabolism in man: A dose-response study. Dig Dis Sci 27:161–168, 1982
Igimi H, Carey MC: pH-solubility relations of chenodeoxycholic and ursodeoxycholic acids: Physical-chemical basis for dissimilar solution and membrane phenomena. J Lipid Res 21:72–90, 1980
Maton PN, Murphy GM, Dowling RH: Ursodeoxycholic acid treatment of gallstones. Dose-response study and possible mechanism of action. Lancet 2:1297–1301, 1977
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Leuschner, U., Leuschner, M., Sieratzki, J. et al. Gallstone dissolution with ursodeoxycholic acid in patients with chronic active hepatitis and two years follow-up. Digest Dis Sci 30, 642–649 (1985). https://doi.org/10.1007/BF01308413
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DOI: https://doi.org/10.1007/BF01308413