Ursodeoxycholic Acid in Liver Cirrhosis: An Evidence-Based Review

Abstract

AbstractUrsodeoxycholic acid (UDCA) is a drug with multiple hepatoprotectant and anticholestatic properties. It is used extensively for the dissolution of gallstones and for the treatment of various cholestatic liver diseases. UDCA modifies the constituents of the bile acid pool, stimulates hepatobiliary secretion, exerts cytoprotective effects, inhibits bile acid absorption by cholangiocytes, and exerts immunomodulatory action. These cytoprotective effects alleviate hepatic inflammation and provide potential anti-fibrotic property of this compound. The mechanism involved in the direct inhibitory fibrogenetic effects is unclear, and the data concerning it is extremely limited. In clinical studies, UDCA has been shown to delay the progression of fibrosis, stabilize portal pressure, and delay development of varices and clinical decompensation in patients with primary biliary cholangitis. The effects of UDCA on liver fibrosis and cirrhosis in other chronic cholestatic disorders show heterogeneous results. In non-cholestatic disorders, UDCA demonstrated limited clinical benefits, and currently, there is insufficient evidence to support its use in these conditions. It should be emphasized that there is a possibility that the treatment duration in the studies may not be of sufficient length for the drug to show the effects, as the fibrosis may progress slowly. Future studies are required to elucidate long-term clinical benefits in conditions, such as cirrhosis, and also to investigate any potential cirrhosis-related complications.KeywordsLiver FibrosisLiver Cirrhosis, BiliaryDeoxycholic AcidPolycyclic CompoundCholestasis, Intrahepatic