Abstract
Gallstone dissolution may be possible only in selected patients. Patients with calcified or large gallstones are not suitable for dissolution. Citrate is normally present in bile and an oral citrate load can increase biliary citrate. A combination of chenodeoxycholic acid (C.D.C.A.) and citrate has been shown to dissolve calcified cholesterol gallstones in vitro. Patients with calcified or large gallstones were treated with a combination of C.D.C.A. and citrate. Partial decalcification was achieved in seven out of twenty patients with calcified stones (35%) and complete decalcification in four patients (20%). One of the patients with large stones had complete dissolution. Five patients who were suitable for C.D.C.A. treatment but did not respond were also treated with C.D.C.A. and citrate. One of the patients in this latter group had complete dissolution. Oral citrate can decalcify some calcified gallstones.
Highlights
It is well established that, if certain criteria are adhered to, patients with radio lucent gall bladder stones can have their stones dissolved with oral bile acid therapy
Resulting gallstone fragments has increased interest in gallstone dissolution. It was first shown in 1980 by Sali and co-workers that citrate is normally present in bile and that citrate concentration of bile can be increased by an oral citrate load Subsequent in vitro studies by this group have shown that calcified pigment stones can be dissolved using citrate solutions alone and calcified cholesterol gallstones can be dissolved using solutions containing both citrate and bile acid2’3
The effect of the combination treatment of C.D.C.A. and citrate on gallstone dissolution, decalcification or disappearance was assessed by a follow-up oral cholecystogram as well as ultrasonography after six months treatment
Summary
It is well established that, if certain criteria are adhered to, patients with radio lucent gall bladder stones can have their stones dissolved with oral bile acid therapy. Up to the present time it has not been possible to dissolve calcified gallstones using oral treatment. The potential of gallstone lithotripsy in the treatment of gall bladder stones and the subsequent need for dissolution of the. Resulting gallstone fragments has increased interest in gallstone dissolution It was first shown in 1980 by Sali and co-workers that citrate is normally present in bile and that citrate concentration of bile can be increased by an oral citrate load Subsequent in vitro studies by this group have shown that calcified pigment stones can be dissolved using citrate solutions alone and calcified cholesterol gallstones can be dissolved using solutions containing both citrate and bile acid2’3. The above findings stimulated a therapeutic trial to dissolve calcified gall bladder gallstones using oral citrate and chenodeoxycholic acid (C.D.C.A.).
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