S1407 Potential Therapeutic Benefit of Ursodeoxycholic Acid (UDCA) in the Management of Non-Hepato-Biliary Upper Gastrointestinal Disorders: A Systemic Review

Abstract

Introduction: Ursodeoxycholic acid (UDCA) is a secondary bile acid with different therapeutic effects on the hepatobiliary tree. Little is known of the local effects of UDCA as a therapy of upper gastrointestinal tract disorders. These diseases that relate to acid peptic, inflammatory and premalignant etiologies in which gaps of the current treatment do exist. Our aim to search for UDCA therapeutic effect and review its role on the management effect of diseases of the esophagus, stomach and Duodenum if exist and describe its therapeutic potential. Methods: Search of Medline, PubMed, EBSO, Google Scholar, Web of Science and International guidelines using MESH terms describing therapy of UDCA for diseases of the upper gastrointestinal disorders in adult humans with no language or publication date restrictions. Results: A 256 articles and 22 guidelines initially identified, in whom 221 excluded, Final revision of 13 article and 22 guidelines showed that UDCA is found to have a cytoprotective role in Barret’s esophagus among esophageal disorders, it improves abdominal pain in functional dyspepsia and does not alter colonization of Helicobacter pylori and its inflammation. In the duodenum a conflicting result on the role of UDCA as chemoprevention for familial adenomatous polyposis, with regression of polyps and its growth characteristics with low doses used (10-25 mg/kg/day) alone. In contrary, no positive effect observed when combined with Celecoxib and with doses of 1000-2000 mg or 20-30 mg/kg/d. Side effects profile is predominantly related to Gastrointestinal side effects and no side effect attributed to morbidity or ICU admission. (Figure) (Table) Conclusion: UDCA has limited therapeutic role in few uncontrolled small studies for functional dyspepsia. Its chemopreventive role is promising for Familial adenomatous polyposis and Barret’s esophagus, await further studies to support these roles.Figure 1. Table 1. - Reported Side effects of UDCA use Type Events (n) Frequency Gastrointestinal • Abdominal Pain (1) 2.5 % • Anal and Perianal Pain (4) 10% • Heartburn (1) 2.5 % • Constipation (3) 7.5 % • Diarrhea (2) 5 % • Bloating (1) 2.5 % • Flatulence (1) 2.5 % • Nausea (1) 2.5 % • Vomiting (1) 2.5 % • Dyspepsia (3) 7.5 % • Terminal ileum Ulceration (1) 2.5 % • Elevated AST and GGT (1) 2.5 % Neurologic • Dizziness (1) 2.5 % • Mood alteration (1) 2.5 % • Neuropathy, Carpal tunnel syndrome (1) 2.5 % Renal • Lower urinary tract symptom, Prostatism (1) 2.5 % Skin • Hair loss (1) 2.5 % • Skin Rash (2) 5% Hematology • Anemia (1) 2.5 % • Leukopenia (1) 2.5 % Auditory • Otitis (1) 2.5 % Infection • Dental Infection (1) 2.5 % • Skin Infection (1) 2.5 % • Gastroenteritis (1) 2.5 % Lymphatics • Lower Limbs edema (2) 5% Metabolic • Hypokalemia (1) 2.5 % Constitutional • Fatigue (2) 5 % • Insomnia (1) 2.5 % Malignancy • Basal cell carcinoma, nose (1) 2.5 % Total Events (n) % 40