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Dissolving stones with drugs

MagazineFebruary 1997 (Vol. 7 Issue 11)Dissolving stones with drugs

For a person who is not suitable for or doesn't want surgery, a number of different drugs are on offer which claim to dissolve gallstones

For a person who is not suitable for or doesn't want surgery, a number of different drugs are on offer which claim to dissolve gallstones. On the surface of it this seems like a much less aggressive alternative to surgery. However, the use of bile acids has a failure rate as high as 50 per cent (BMJ, 1995; 311: 99-105), and even if they do dissolve the gallstones, the recurrence rate can be as high as 50 per cent (J Hepatol, 1986; 3: 241-6).

Furthermore, the number of patients who are treatable by this method are quite small 20 per cent of all patients.Bile acids are most useful when stones are under 10 mm in diameter (Aliment Pharmacol Ther, 1993; 7(2): 139-48), and often only partial dissolution is achieved (Gut, 1992; 33(5): 698-700; Acta Gasteroenterol Latinoamericana, 1994; 24(4): 233-7).

In addition, many of these drugs have unwelcome side effects of their own. Oral remedies for cholesterol gallstones such as chenodeoxycholic acid (CDCA) and urodeoxycholic acid (UDCA) are the remedies of choice. But UDCA (ursidol) has been known to cause severe abdominal pain (N Eng J Med, 1993; 328: 1502; Digestive Dis Sci, 1994; 39(9): 1981-4). In one study its use resulted in a non functioning gallbladder in 9 per cent of cases and gallstone calcification (hardening) was seen in a further 15 per cent (Scand J Gastroenterol, 1993; 28(3): 267-73).

Other dissolving agents such as methyl tert butyl ether which are injected directly into the gallbladder via a catheter bring their own problems. The siting of the catheter can be unsuccessful, leading to possible surgery, anyway (Zeitschrift fr Gastroenterol, 1992; 30(7):459-62). Some patients experience nausea and transient abdominal pains (Digestive Disease Sci, 1992; 37(1):97-100).

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