Treatment of Radiolucent Gallstones with CDCA or UDCA

Abstract

Patients with radiolucent gallstones (diameter < 1.5 cm) and functioniing gallbladder were treated for 6-12 mo. with CDCA (chenodeoxycholic acid; 38 patients, 12-15 mg/kg/day) or UDCA (ursodeoxycholic acid; 78 patients randomly allocated to receive 5-6 or 10-12 mg/kg per day). Complete dissolutions and partial plus complete dissolutions were, respectively, 26 and 58% for CDCA, 14 and 58% for UDCA at the lower dose and 29 and 71% for UDCA at the higher dose. Statistical analysis did not show any significant difference between the 3 different treatments. In patients with stones of 4-10 mm diameter treated with UDCA, complete dissolution occurred at the lower dose in 0 of 14 cases while complete dissolutions occurred at the higher dose in 5 of 18 cases, suggesting that the latter dose may be more effective (0.05 < P < 0.1). A highly significant correlation was demonstrated between gallstone size and number of dissolutions with the 2 doses of UDCA. No side effects were observed with UDCA, while with CDCA diarrhea occurred in 28% and a transient increase in SGOT [serum glutamic oxaloacetic transaminase] in a single patient. One patient on UDCA required emergency cholecystectomy for acute cholecystitis. Dyspeptic and/or pain symptomatology improved in 65 and 85% of the patients treated with CDCA and UDCA, respectively. No variations in blood lipids were observed.