What's New? Oral Dissolution Therapy for Gallstone

Lee, Dong Ki

Abstract

The standard treatment of the gallbladder stone is laparoscopic cholecystectomy, making gallstone disease very costly digestive disorder in many countries. Despite a rapid convalescence, the procedure is not devoid of morbidity or even mortality. Bile duct injury is particularly troublesome. In patients with mild symptoms, surgical treatment has been associated with a higher mobidity than the natural course of the disease. Medical dissolution therapy with bile acids is an alternative for patients with mild-to-moderate symptoms due to cholesterol gallstones. The main drawbacks of bile acid(UDCA) treatment are its low efficacy, delay in action, and the possibility of stone recurrence. However, this treatment is extremely safe, and the efficacy and delay can be somewhat improved by stricter patient selection. Moreover, patient symptoms may respond to this therapy even without complete stone dissolution. Long-term UDCA therapy is clearly associated with reduced risk of biliary pain and acute cholecystitis due to its anti-inflammatory effect. New strategies employing more efficient bile acids or related compounds may increase the efficacy of medical dissolution. Fish oil(n-3) polyunsaturated fatty acids decreases biliary cholesterol saturation in the bile of gallstone patients by increasing the proportion of phospholipids in bile or modulating their molecular composition, preventing cholesterol crystallization. Natural fish oil or synthesised fatty acid bile acid conjugates may be of potential use in cholesterol gallstone disease in humans. After several years of relative stagnation, we are entering a new era of potential avenues for the revival of medical therapy for gallstone disease.