NONSURGICAL APPROACH TO GALLSTONES - ORAL-THERAPY WITH BILE-ACIDS

Gallstone disease is very common. According to recent epidemiological studies it affects 6.4% of men and 10.4% of women between 30-69 years of age. In more than half of these the disease remains asymptomatic. Until fairly recently cholecystectomy was the only available treatment. However, in the early '70's, ursodeoxycholic acid (UDCA) and chenodeoxycholic acid (CDCA) were introduced as possible alternatives to surgery. Nonetheless, not everyone with gallstones can or should be given this type of treatment. Whilst it is commonly agreed that symptomatic gallstones must be operated on, there is no such agreement regarding treatment with biliary acid per os for asymptomatic stones. However, only asymptomatic subjects with radiolucent stones in a functioning gallbladder, no larger than 15 mm in diameter, can be treated with a good rate of success-as high as 50% after one year of treatment. The biliary acid currently used, either alone or together with CDCA, is UDCA. The average dose is 8-10 mg/kg/day. There are few side effects and in practice there are no contraindications to such treatment. The cost of the treatment is not prohibitive: 750 mg/day of UDCA in Italy costs about $1540 for a year's supply.