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Drug and treatment efficacy of chenodeoxycholic acid in 97 patients with cholelithiasis and increased surgical risk

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Abstract

Patients with symptomatic cholelithiasis who represent higher than normal surgical risks may be the most suitable candidates for medical dissolution of gallstones. Chenodeoxycholic acid was given to 97 patients in a dosage of 15 mg/kg of body weight per day for a period of two years. Complete gallstone dissolution occurred in 27 of 97 patients (28%). If dropouts are excluded then the success rate is 27 of 64 patients (42%). Diarrhea was a common but manageable side effect for most. Thirty-two percent of patients developed chemical liver test abnormality; however, in only 13% was the degree of abnormality sufficient to require temporary (3%) or permanent (10%) cessation of therapy. Although better chemotherapeutic agents are needed, chenodeoxycholic acid is a reasonable choice for patients with non-calcified cholelithiasis in a functioning gallbladder if the patient is a heightened surgical risk. Because of the prolonged treatment period and the possibility of hepatotoxicity this treatment program requires a substantial commitment on the part of both the patient and the physician.

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References

  1. Danzinger RG, Hoffmann AF, Schoenfield LF, Thistle JL: Dissolution of cholesterol gallstones by chenodeoxycholic acid. N Engl J Med 286:1–8, 1972

    Google Scholar 

  2. Hofmann AF: The medical treatment of cholesterol gallstones. A major advance in preventive gastroenterology. Am J Med 66:4–7, 1980

    Google Scholar 

  3. Schoenfield LF: Manifestations of cholelithiasis.In Diseases of the Gallbladder and Biliary System. LJ Schoenfield (ed). New York, Wiley, 1977, pp 108–69

    Google Scholar 

  4. Iser JH, Dowling RH, Mok HYI, et al: Chenodeoxycholic acid treatment of gallstones. A follow up report and analysis of factors influencing response to therapy. N Engl J Med 293:378–383, 1975

    Google Scholar 

  5. Pearlman BJ, Schoenfield LF: Gallstones—the present and future of medical dissolution. Med Clin North Am 62:87–105, 1978

    Google Scholar 

  6. Gerolami A, Sarles H, Brette R: Controlled trial of chenodeoxycholic acid therapy for radiolucent stones. A multicenter study. Digestion 16:299–307, 1977

    Google Scholar 

  7. Schoenfield LJ, Lachin JM: Steering committee of the National Cooperative Gallstone Study Group: Chenodiol (chenodeoxycholic acid) for dissolution of gallstones. The National Cooperative Gallstone Study—a controlled trial of efficacy and safety. Ann Intern Med 95:257–282, 1981

    Google Scholar 

  8. Brownlee KA: Statistical Theory and Methodology in Science and Engineering. 2nd ed, 1965. John Wiley & Sons, New York

    Google Scholar 

  9. Neter J, Wasserman W: Applied Linear Statistical Models, 1974. Richard D. Irwin, Inc. Homewood IL

    Google Scholar 

  10. Hollander M, Wolfe DA: Nonparametric Statistical Methods, 1973. John Wiley & Sons, New York

    Google Scholar 

  11. Marks JW, Sherman JH, Bonorris GG, Chung A, Coyne MG, Schoenfield LJ: Gallstone dissolution by chenodeoxycholic acid and phenobarbital. Am J Gastroenterol 69:160–165, 1978

    Google Scholar 

  12. Thistle JL, Hofmann AF, Ott BJ, Stephens DH: Chenotherapy for gallstone dissolution: Efficacy and safety. J Am Med Assoc 239:1041–1046, 1978

    Google Scholar 

  13. Danzinger RG, Kurtas TK, Torchia MG: Low dose chenodeoxycholic acid for gallstone dissolution: a randomized trial in poor operative risk patients. Dig Dis Sci 25:785–789, 1980

    Google Scholar 

  14. Trotman BW, Soloway RD: Pigment vs cholesterol cholelithiasis: Clinical and epidemiological aspects. Am J Dig Dis 20:735–740, 1975

    Google Scholar 

  15. Leuschner U, Reber E, Erb W: Treatment of patients with gallstones with chenodeoxycholic acid. Dtsch Med Wochenschr 102:156–160, 1977

    Google Scholar 

  16. Whiting MJ, Jarvinen V, MckWatts J: Chemical composition of gallstones resistant to dissolution therapy with chenodeoxycholic acid. Gut 21:1077–1081, 1980

    Google Scholar 

  17. Iser JH, Maton PN, Murphy GM, Dowling RH: Resistance to chenodeoxycholic acid (CDCA) treatment in obese patients with gallstones. Br Med J 1:1509–1512, 1978

    Google Scholar 

  18. Maton PH, Murphy GM, Dowling RH: Lack of response to chenodeoxycholic acid in obese and non-obese patients. Gut 21:1082–1086 1978

    Google Scholar 

  19. Mohler DN, Wallis DG, Dreyfus DG: Studies in the home treatment of streptococcal disease. I. Failure of patients to take pencillin by mouth as prescribed. N Engl J Med 252:1116–1118, 1955

    Google Scholar 

  20. Lunts GRWN, Austin R: New stick test for PAS in urine: Report on use of “phenistix” and problems of long term chemotherapy for tuberculosis. Br Med J 1:1679–1684, 1960

    Google Scholar 

  21. Blackwell B: The drug defaulter. Clin Pharmacol Ther 13:841–848, 1972

    Google Scholar 

  22. Webster KH, Lancaster MC, Hofmann AF: Influence of primary bile and acid feeding on cholesterol metabolism and hepatic function in the Rhesus Monkey. Mayo Clin Proc 50:134–138, 1975

    Google Scholar 

  23. Morrissey KP, McSherry CK, Swarm RL, Nieman WH, Deitrick JE: Toxicity of chenodeoxycholic acid in the non-human primate. Surgery 77:851–860, 1975

    Google Scholar 

  24. Danielson H, Eneroth K, Heliström K, Lindstedt S, Sjövall J: On the turnover and excretory products of cholic and chenodeoxycholic acid in man. J Biol Chem 238:2299–2304, 1963

    Google Scholar 

  25. Marks JW, Sue SO, Pearlman BJ: Sulfation of lithocholate as a possible modifier of chenodeoxycholic acid-induced elevations of serum transaminase in patients with gallstones. J Clin Invest 68:1190–1196, 1981

    Google Scholar 

  26. Koch MM, Giampieri MP, Lorenzini I, Jezequel AM, Orlandi F: Effect of chenodeoxycholic acid on liver structure and function in man: A stereological and biochemical study. Digestion 20:8–21, 1980

    Google Scholar 

  27. Fisher RL, Anderson DW, Boyer JL, Ishak K, Klatskin G, Lachin JM, Phillips MJ: A prospective morphological evaluation of hepatic toxicity of chenodeoxycholic acid in patients with cholelithiasis: The National Cooperative Gallstone Study. Hepatology 2:187–201, 1982

    Google Scholar 

  28. Phillip MJ, Fisher RL, Anderson DW, Lan SP, Lachin JM, Boyer JL: Ultra structural evidence of intrahepatic cholestasis before and after chenodeoxycholic acid therapy in patients with cholelithiasis. The Steering Committee, The National Cooperative Gallstone Study. Hepatology 3:209–220, 1983

    Google Scholar 

  29. Nakagawa S, Makino I, Ishizaki T, Dohi I: Dissolution of cholesterol gallstones by ursodeoxycholic acid. Lancet 2:367–369, 1977

    Google Scholar 

  30. Maton PN, Murphy GM, Dowling RH: Ursodeoxycholic acid treatment in gallstones. Lancet 2:1297–1300, 1977

    Google Scholar 

  31. Tokyo Cooperative Gallstone Study Group. Efficacy and indications of ursodeoxycholic acid treatment for dissolving gallstones. Gastroenterology 78:542–548, 1980

    Google Scholar 

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Tangedahl, T., Carey, W.D., Ferguson, D.R. et al. Drug and treatment efficacy of chenodeoxycholic acid in 97 patients with cholelithiasis and increased surgical risk. Digest Dis Sci 28, 545–551 (1983). https://doi.org/10.1007/BF01308157

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  • DOI: https://doi.org/10.1007/BF01308157

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