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Efficacy of bile acid therapy for gallstone dissolution: a meta‐analysis of randomized trials
Author(s) -
MAY G. R.,
SUTHERLAND L. R.,
SHAFFER E. A.
Publication year - 1993
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.1993.tb00082.x
Subject(s) - ursodeoxycholic acid , medicine , gallstones , chenodeoxycholic acid , cholecystography , radiodensity , gastroenterology , deoxycholic acid , gallbladder , placebo , meta analysis , bile acid , surgery , radiography , pathology , alternative medicine
SUMMARY To define better the efficacy of bile acid therapy for dissolution of radiolucent gallstones, we performed a meta‐analysis of published trials from January 1966 to September 1992. Studies were identified using a MEDLINE computer search followed by an extensive manual search. The inclusion criteria used were: randomized trial, radiolucent gallstones in a visualizing gallbladder on oral cholecystography, and complete stone dissolution confirmed by oral cholecystography or ultrasound. Study results were pooled into 6 groups: placebo: high‐ and low‐dose chenodeoxycholic acid (CDCA) (≥10 mg.kg/day and < 10 mg.kg/day); high‐ and low‐dose ursodeoxycholic acid (UDCA) (< 7 mg. kg/day and < 7 mg. kg/day) and combined CDCA plus UDCA. Homogeneity calculations were performed and the percentage of complete stone dissolution calculated for each group with 95% confidence intervals. Of 66 trials identified, 23 comprising 1949 patients met the inclusion criteria. A total of 1062 patients were treated with CDCA, 819 with UDCA and 78 combination therapy. In studies > 6 months' duration, high‐dose UDCA completely dissolved stones in 37.3% of patients (95% C.I. 33–42%), low‐dose UDCA in 20.6%) and high‐dose CDCA 18.2% (95% C.I. 15–21%). Based on only two studies, combination therapy achieved dissolution in 62.8% (95% C.I. 51–74%) of patients. Stones less than 10 mm dissolved significantly more frequently than stones larger than 10 mm. This analysis shows that UDCA in doses greater than 7 mg. kg/day taken for greater than 6 months will dissolve radiolucent gallstones in 38% of patients. The combination of UDCA and CDCA may be more efficacious but this observation is based upon only 78 patients and requires confirmation in further randomized trials.