Nucleation Time, Cholesterol Saturation Index, and Biliary Bile Acid Pattern:A Comparison in Responders and Nonresponders to Systemic Litholysis with Bile Acids

Abstract

In a 24-month trial of a combination therapy with ursodeoxycholic acid and cheno-deoxycholic acid complete dissolution of radiolucent gallstones was achieved in 15 of 55 patients (27.3%). A decrease of stone volume of >35% was achieved in a further 28 patients (50.9%). In 12 patients (21.8%) inadequate compliance (3.6%), a non-functioning gallbladder (3.6%), absence of size decrease (10.9%), or acute cholecystitis (3.6%) required interruption of therapy. Determination of the cholesterol saturation index (CSI) did not facilitate patient selection, nor was there a statistically significant difference between responders and nonresponders to dissolution therapy. In the course of treatment the average CSI showed a statistically significant decrease from 1.54 ± 0.12 to 0.82 ± 0.06 (p < 0.001). Patients in whom complete dissolution was achieved and those in whom no improvement was observed differed significantly in nucleation time (4.7 ± 0.8 versus 15.0 ± 2.2 days; p <0.001) and initial gallstone volume (274 ± 78 versus 1045 ± 180 mm³). The nucleation time increased statistically significantly during the therapy in the successfully treated group. The percentages of glycocholic acid (8.1 ± 1.13 versus 4.1 ±0.55%; p < 0.01), taurocholic acid (2.2 ± 0.45 versus 0.8 ± 0.23%; p<0.05), and glycodeoxycholic acid (4.9 ± 0.70 versus 1.4 ± 0.37%; p < 0.001) were statistically significantly different after the treatment. There were no statistically significant differences between patients with complete and incomplete stone dissolution with regard to age, mean body weight, or laboratory variables.

Key Words:

• Bile acids
• chenodeoxycholic acid
• cholesterol saturation index
• gallstones
• gallstone therapy
• nucleation time
• systemic litholysis
• ursodeoxycholic acid