A meta-analysis of randomized trials (n=23) in 1949 patients assessed the efficacy of bile-acid therapy (chenodeoxycholic acid or ursodeoxycholic acid) for dissolution of cholesterol gallstones 1. 9 of the trials were placebo controlled.
The analysis concludes that UDCA is superior to CDCA, that high doses have better success rates than low doses, and that outcomes are markedly better in persons with stones < 10 mm in diameter. Even under such favourable circumstances, only roughly half of patients will be free of gallstones after treatment for 6 months or more.
Bile-acid therapy has other drawbacks besides its low success rate. Treatment is often required for 1 year or longer.
The overall dissolution rate was 18.6% (CI, 14% to 23%) in studies on low-dose UDCA, 31.9% in trials on high-dose UDCA and 31.9% (CI, 28% to 37%). When UDCA was taken for > 6 months the overall dissolution rates increased to 20.6% (CI, 15.0% to 26.1%) for low doses and 37.3% (CI,32.7% to 42.0%) for high doses. The dissolution rate with UDCA was better for small stones (< 10 mm) than for large stones (48.5% (CI, 41% to 56%) vs. 28.8% (CI, 22% to 36%); P <
0.001 for the difference).
Recurrence is common after dissolution, particularly if there were multiple stones 2.
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