Ursodeoxycholic acid versus chenodeoxycholic acid: Comparison of their effects on bile acid and bile lipid composition in patients with cholesterol gallstones

Abstract

Chenodeoxycholic acid (cheno) and ursodeoxycholic acid (urso) dissolve cholesterol gallstones in man. In the present study the effects of cheno and urso were investigated in a prospective study in 10 patients in which every patient served as his own control. Five patients were first treated with cheno and subsequently with urso, and 5 patients were first treated with urso and subsequently with cheno. Each of the treatment periods lasted for 3 months. Cheno and urso were administered in daily doses of 12.7 to 17.9 mg per kg. In the control period biliary bile acids consisted of 40.7 ± 4.0% cheno, 1.4 ± 0.2% urso, 1.1 ± 0.1% lithocholic acid, and 0.7 ± 0.2% lithocholic acid sulfate. During treatment with cheno this bile acid increased in bile to 84.3 ± 1.6%, urso to 4.6 ± 1.2%, lithocholic acid to 2.0 ± 0.2%, and lithocholic acid sulfate increased to 1.6 ± 0.2%. In plasma cheno, lithocholic acid and lithocholic acid sulfate were increased. During treatment with urso this bile acid increased in bile to 57.1 ± 3.5% while cheno decreased to 17.9 ± 1.3%, lithocholic acid to 0.6 ± 0.1%, and lithocholic acid sulfate to 0.5 ± 0.1% of total biliary bile acids. In plasma only urso increased. Cholesterol saturation of bile decreased during both treatment periods but was significantly lower during urso treatment (0.6 ± 0.1) than during cheno treatment (0.8 ± 0.1). In 4 patients maximal SGPT values were elevated during the cheno treatment period in comparison to the control period and urso treatment period. All other liver function tests and also serum lipids were unchanged during both treatment periods.