Overall Strategy

  • T. C. Northfield
  • R. P. Jazrawi


The first requirement in tackling this broad subject is a satisfactory definition of strategy. Since the subject concerns the war against gallstone disease, and since this book is an international undertaking, we thought it appropriate to consult the writings of a famous military strategist, Von Clausewitz. He states that ‘die Strategie ist der Gebrauch des Gefechts zum Zweck des Krieges’. This is translated as ‘strategy is the use of battles for the object of the war’. Thus, strategy consists of relating methods to a clearly defined object. We would define the object of the war against gallstone disease as being ‘to ensure that as many gallstone patients as possible are maintained free of gallstones in the long term’. In order to achieve this object, we have at present three non-surgical methods that we can use - a physical approach (fragmentation therapy or extracorporeal shock wave lithotripsy), a chemical approach (the use of chemical solvents, in particular methyl tert-butyl ether) and a physico-chemical approach (bile acid therapy using chenodeoxycholic acid (CDCA) and/or ursodeoxycholic acid UDCA)).


Bile Acid Extracorporeal Shock Wave Lithotripsy Gallstone Disease Chenodeoxycholic Acid Steady State Situation 
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  1. 1.
    Ransohoff, D.F. (1985). Natural history of silent gallstones. In Paumgartner, G., Stiehl, A. and Gerok, W. (eds.) Enterohepatic Circulation of Bile Acids and Sterol Metabolism. pp. 277–84 (Lancaster: MTP Press)Google Scholar
  2. 2.
    Attili, A.F. (1986). Natural history and prevention. In Bateson, M. (ed.) Gallstone Disease and its Management, pp. 57–70. (Lancaster: MTP Press)Google Scholar
  3. 3.
    Paumgartner, G. (1988). In Northfield, T.C., Jazrawi, R. and Zentler-Munro, P.L. (eds.) Bile Acids in Health and Disease. Ch. 15. (Lancaster: MTP Press)Google Scholar
  4. 4.
    Thistle, J.L. (1988). In Northfield, T.C., Jazrawi, R. and Zentler-Munro, P.L. (eds.) Bile Acids in Health and Disease Ch. 14. (Lancaster: MTP Press)Google Scholar
  5. 5.
    Hospital in-patient enquiry, 1985. Series HB4 No. 27. DHSS Office of Population Censuses and Surveys. HMSO London, 1987Google Scholar
  6. 6.
    Pounder, R. (1981). Model of medical treatment for duodenal ulcer. Lancet, 1, 29–30PubMedCrossRefGoogle Scholar
  7. 7.
    Hood, K. (1988). In Northfield, T.C., Jazrawi, R. and Zentler-Munro, P.L. (eds.) Bile Acids in Health and Disease. Ch. 11. (Lancaster: MTP Press)Google Scholar
  8. 8.
    Kupfer, R.M., Maudgal, D.P. and Northfield, T.C. (1982). Gallstone dissolution rate during chenic acid therapy. Effect of bedtime administration plus low cholesterol diet. Dig. Dis. Sci., 27, 1025–29PubMedCrossRefGoogle Scholar
  9. 9.
    Maton, P.N., Iser, J.H., Reuben, A., Saxton, H.M., Murphy, G.M. and Dowling, R.H. (1982). The final outcome of CDCA-treatment in 125 patients with radiolucent gallstones: factors influencing efficacy, withdrawal, symptoms and side effects and postdissolution recurrence. Medicine, 61, 85–96CrossRefGoogle Scholar
  10. 10.
    Ruppin, D.C. and Dowling, R.H. (1982). Is recurrence inevitable after gallstone dissolution by bile acid treatment? Lancet, 1, 181–5PubMedCrossRefGoogle Scholar
  11. 11.
    Lanzini, A., Jazrawi, R.P. and Northfield, T.C. (1986). Gallstone recurrence after medical dissolution: an over-estimated threat? J. Hepatol, 3, 241–6PubMedCrossRefGoogle Scholar
  12. 12.
    Northfield, T.C. and Jasrawi, R.P (1988). Patient selection for bile acid therapy. In Paumgartner, G., Stiehl, A. and Gerok, W. (eds) Bile Acids and the Liver, pp. 329–342, (Lancaster: MTP Press)Google Scholar

Copyright information

© Kluwer Academic Publishers 1988

Authors and Affiliations

  • T. C. Northfield
    • 1
  • R. P. Jazrawi
    • 1
  1. 1.Department of Medicine IISt George’s Hospital Medical SchoolLondonUK

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