Treatment of Gallstones with Chenodeoxycholic Acid and Phenobarbital

Abstract

In a controlled trial, 36 patients with asymptomatic radiolucent gallstones were treated with chenodeoxycholic acid, 750 mg per day, phenobarbital, 180 mg per day, combination of both drugs, and placebo. After one year, chenodeoxycholic acid, phenobarbital and the combination, but not placebo, significantly decreased biliary cholesterol saturation. This effect was significantly greater with chenodeoxycholic acid and the combination than with phenobarbital. Gallstone size decreased more than 50 per cent in nine of 20 patients receiving chenodeoxycholic acid, either alone or combined with phenobarbital, but in no patient receiving only phenobarbital or placebo. Gallstones disappeared completely in two patients receiving the combination. Abnormalities in liver-function tests in three of 36 patients, and in five of 16 liver biopsies, occurred with equal frequency in the four treatment groups. Thus, after one year, phenobarbital alone was ineffective in gallstone dissolution. Chenodeoxycholic acid alone or combined with phenobarbital, however, offered a partially effective and safe treatment for asymptomatic radiolucent gallstones. (N Engl J Med 292:604–607, 1975)