Epidemiology and medical treatment of cholesterol gallstones: recurrence, post-dissolution management and the future

  • R. H. Dowling


The results of epidemiological studies, now based mainly on ultrasound screening, tell us that in developed societies the prevalence of gallstones is approximately 10%l .When combined with clinical assessment they also tell us that approximately two-thirds of gallstone carriers are unaware that they have stones2 3. In other words, the majority of gallstones diagnosed in this way are silent or asymptomatic. Indirect support for the concept that ‘the innocent gallstone is not a myth’4 comes from comparisons between prevalence rates for cholelithiasis and cholecystectomy rates in any given community. Even though the frequency with which cholecystectomy is carried out varies considerably from country to country5, and despite the fact that surgical removal of the gallbladder is now the most common abdominal operation performed in Western society6, it is clear that only a minority of gallstone carriers will ever come to surgery. By inference, therefore, the majority of patients with cholelithiasis are either unaware of their stones or have related symptoms which the patient, the doctor (or both) judge to be tolerable.


Bile Acid Ursodeoxycholic Acid Gallstone Disease Chenodeoxycholic Acid Cholesterol Gallstone 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Ingelfinger, F. J. (1968). Digestive disease as a national problem. V. Gallstones. Gastroenterology, 55, 102–104PubMedGoogle Scholar
  2. 2.
    Ricci, G. (1983). The Grepco Study: aims, methodology and prevalence data. In Abstracts of International Workshop on Epidemiology and Prevention of Gallstone Disease, Rome, December 1983Google Scholar
  3. 3.
    Barbara, L. (1983). Epidemiology of gallstone disease: the Sirmione Study. In Abstracts of International Workshop on Epidemiology and Prevention of Gallstone Disease, Rome, December 1983Google Scholar
  4. 4.
    Gracie, W. A. and Ransohoff, D. F. (1982). The natural history of silent gallstones: the innocent gallstone is not a myth. N. Engl. J. Med., 307, 798–800PubMedCrossRefGoogle Scholar
  5. 5.
    Fisher, M. M. (1979). Perspectives in gallstones. In Fisher, M. M., Goresky, C. A., Shaffer, E. A. and Strasberg, S. M. (eds.) Gallstones, pp. 1–17. ( New York: Plenum )Google Scholar
  6. 6.
    Holland, C. and Heaton, K. W. (1972). Increasing frequency of gallbladder operations in the Bristol clinical area. Br. Med. J., 3, 672–675PubMedCrossRefGoogle Scholar
  7. 7.
    Lund, J. (1960). Surgical indications in cholelithiasis: prophylactic cholecystectomy elucidated on the basis of long-term follow-up on 526 non operated cases. Ann. Surg., 151, 153–162PubMedCrossRefGoogle Scholar
  8. 8.
    Wenckert, A. and Robertson, B. (1966). The natural course of gallstone disease. Eleven-year review of 871 nonoperated cases. Gastroenterology, 50, 376–381PubMedGoogle Scholar
  9. 9.
    Donaldson, R. M. Jr (1982). Advice for the patient with ‘silent’ gallstones. N. Engl J. Med., 307, 815–817PubMedCrossRefGoogle Scholar
  10. 10.
    Dowling, R. H. (1982). Cholelithiasis: medical treatment. Clin. Gastroenterol., 12, 125–178Google Scholar
  11. 11.
    Northfield, T. C., LaRusso, N. F., Hofmann, A. F. and Thistle, J. L. (19 75). Biliary lipid output during three meals and an overnight fast. II. Effect of chenodeoxycholic acid treatment in gallstone subjects. Gut, 16, 12–17PubMedCrossRefGoogle Scholar
  12. 12.
    von Bergmann, K., Gutsfeld, M., Schulze-Hagen, K. and von Unruh, G. (1979). Effects of ursodeoxycholic acid on biliary lipid secretion in patients with radiolucent gallstones. In Paumgartner, G., Stiehl, A. and Gerok, W. (eds.) Biological Effects of Bile Acids, pp. 61–66. ( Lancaster: MTP Press )Google Scholar
  13. 13.
    Thistle, J. L. and Schoenfield, L. J. (1971). Induced alterations in composition of bile of persons having cholelithiasis. Gastroenterology, 61, 488–496PubMedGoogle Scholar
  14. 14.
    Maton, P. N., Murphy, G. M. and Dowling, R. H. (1977). Ursodeoxycholic acid treatment of gallstones. Dose-response study and possible mechanism of action. Lancet, 2, 1297–1301PubMedCrossRefGoogle Scholar
  15. 15.
    Schoenfield, L. J., Lachin, J. M., the NCGS Steering Committee and the NCGS Group (1981). National Cooperative Gallstone Study: A controlled trial of the efficacy and safety of chenodeoxycholic acid for dissolution of gallstones. Ann. Intern. Med., 95, 257–282PubMedGoogle Scholar
  16. 16.
    Leuschner, U. (1977). Dissolution of biliary cholesterol calculi using chenodeoxycholic acid. Internist, 18, 114–115PubMedGoogle Scholar
  17. 17.
    Leuschner, U., Leuschner, M. and Stromm, W. D. (1982). Our 10 years’ experience in gallstone dissolution. Comparison with the National Cooperative Gallstone (NCGS, USA) and the Tokyo Cooperative Gallstone Study (TCGS, Japan). Gastroenterology, 80, 1113 (abstract)Google Scholar
  18. 18.
    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 12 5 patients with radiolucent gallstones: factors influencing efficacy withdrawal, symptoms and side effects and post-dissolution recurrence. Medicine (Baltimore), 61, 85–96Google Scholar
  19. 19.
    Dowling, R. H., Hofmann, A. F. and Barbara, L. (1978). Workshop on Ursodeoxycholic Acid. ( Lancaster: MTP Press )Google Scholar
  20. 20.
    Bachrach, W. H. and Hofmann, A. F. (1982). Ursodeoxycholic acid in the treatment of cholesterol cholelithiasis: a review. Dig. Dis. Sci., 27, 737–761PubMedCrossRefGoogle Scholar
  21. 21.
    Tokyo Cooperative Gallstone Study Group (1980). Efficacy and indications of ursodeoxycholic acid treatment for dissolving gallstones. Gastroenterologic, 78, 542–548Google Scholar
  22. 22.
    Bateson, M. C., Bouchier, I. A. D., Trash, D. B., Maudgal, D. P. and Northfield, T. C. (1981). Calcification of radiolucent gall stones during treatment with ursodeoxycholic acid. Br. Med. J., 283, 645–656CrossRefGoogle Scholar
  23. 23.
    Raedsch, R., Stiehl, A. and Cyzgan, P. (1983). Ursodeoxycholic acid and gallstone calcification. Lancet, 2, 1296 (Letter to editor)Google Scholar
  24. 24.
    Gleeson, D., Ruppin, D. C., Murphy, G. M. and Dowling, R. H. (1983). Second look at ursodeoxycholic acid (UDCA): high efficacy for partial but low efficacy for complete gallstone dissolution, and a high rate of acquired stone opacification. Gut, 24, A999–A1000 (abstract)Google Scholar
  25. 25.
    Whiting, M., Jarvinen, V. and Watts, J. (1980). Chemical composition of gallstones resistant to dissolution therapy with chenodeoxycholic acid. Gut, 21, 1077–1081PubMedCrossRefGoogle Scholar
  26. 26.
    Sarva, R., Farivar, S., Fromm, H. and Poller, W. (1981). Study of the sensitivity and specificity of computerized tomography in the detection of calcified gallstones which appear radiolucent by conventional roentgenography. Gastrointest. Radiol., 6, 165–167PubMedCrossRefGoogle Scholar
  27. 27.
    Roda, E., Bazzoli, F. and Labate, A. M. M. (1982). Ursodeoxycholic acid vs. chenodeoxycholic acid as cholesterol gallstone-dissolving agents: a comparative randomized study. Hepatology, 2, 804–810PubMedCrossRefGoogle Scholar
  28. 28.
    Fromm, H., Roat, J. W., Gonzalez, V., Sarva, R. P. and Farivar, S. (1983). Comparative efficacy and side effects of ursodeoxycholic and chenodeoxycholic acids in dissolving gallstones. Gastroenterology, 85, 1257–1264PubMedGoogle Scholar
  29. 29.
    Ruppin, D. C., Maton, P. N., Williams, G. V., Merdith, T. J., Murphy, G. M., and Dowling, R. H. (1982). Ursotherapy for cholesterol gallstones? Ital. J. Gastroenterol., 15, (abstract; in press)Google Scholar
  30. 30.
    Somerville, K. W., Rose, D. H. and Bell, G. D. (1982). Gall-stone dissolution and recurrence: are we being misled? Br. Med. J., 284, 1295–1297CrossRefGoogle Scholar
  31. 31.
    Shapero, T. F., Rosen, I. E., Milson, S. R. and Fisher, M. M. (1982). Discrepancy between ultrasound and oral cholecystography in the assessment of gallstone dissolution. Hepatology, 2, 587–590.PubMedCrossRefGoogle Scholar
  32. 32.
    Baddley, H., Nolan, D. J. and Slamon, P. R. (1978). Radiological Atlas of Biliary and Pancreatic Disease. ( Aylesbury: HM&M )Google Scholar
  33. 33.
    Jacobus, D. P., Trout, J. R., Greenwell, B. E., Schoenfield, L. J. and Lachin, J. M. (1983). The natural history and the therapeutic response to Chenodiol in patients with floatable stones in the National Co-operative Gallstone Study (NCGS). Gastroenterology, 84, 1197 (abstract)Google Scholar
  34. 34.
    Dumont, M., Erlinger, S. and Uchman, S. (1980). Hypercholeresis induced by ursodeoxycholic acid and 7-ketolithocholic acid in the rat. Possible role of bicarbonate transport. Gastroenterology, 79, 82–89PubMedGoogle Scholar
  35. 35.
    Batta, A. K., Salen, G., Shefer, S., Tint, G. S. and Dayal, B. (1982). The effect of tauroursodeoxycholic acid and taurine supplementation on biliary bile açid composition. Hepatology, 2, 811–816PubMedCrossRefGoogle Scholar
  36. 36.
    Bell, G. D., Dowling, R. H., Whitney, B. and Sutor, D. J. (1975). The value of radiology in predicting gallstone type when selecting patients for medical treatment. Gut, 16, 359–364.PubMedCrossRefGoogle Scholar
  37. 37.
    Trotman, B. W., Petrella, E. J., Soloway, R. D., Sanchez, H., Morris, T. A., III and Miller, W. T. (1975). Evaluation of radiographic lucency or opaqueness of gallstones as a means of identifying cholesterol or pigment stones. Correlation of lucency or opaqueness with calcium and mineral. Gastroenterology, 68, 1563–1566PubMedGoogle Scholar
  38. 38.
    Bruusgaard, A., Sorensen, T. I. A., Justensen, T. and Krag, E. (1976). Bile acid metabolism after jejunoileal bypass operation for obesity. Scand. J. Gastroenterol., 11, 833–838PubMedGoogle Scholar
  39. 39.
    Maton, P. N., Murphy, G. M. and Dowling, R. H. (1980). Lack of response to chenodeoxycholic acid in obese and non-obese patients. Gut, 21, 1082–1086PubMedCrossRefGoogle Scholar
  40. 40.
    Fisher, M. M., Roberts, E. A., Rosen, I. E. and Wilson, S. R. (1982). The efficacy of chenodeoxycholic acid in the dissolution of gallstones. In Bile Acids and Cholesterol in Health and Disease. I. Abstracts, 7th International Bile Acid Meeting, Basel, pp. 256–257Google Scholar
  41. 41.
    Gleeson, D., Ruppin, D. C. and Dowling, R. H. (1983). British Gallstone Study Group (BGSG) post-dissolution trial: interim report on overall recurrence rates and discrepancies between ultrasonography (US) and oral cholecystography (OCG). Gut, 24, A1006 (abstract)Google Scholar
  42. 42.
    Ruppin, D. C. and Dowling, R. H. (1982). Is recurrence inevitable after gallstone dissolution by bile acid treatment? Lancet, 1, 181–185PubMedCrossRefGoogle Scholar
  43. 43.
    Toulet, J., Rousselet, J., Viteau, J.-M., Duchon, Y., Pagniez, R., Samain, B. and Vienne, J.-L. (1983). Récidives et prévention des récidives après dissolution de la lithiase vésiculaire par l’acide chénodésoxycholique chez 22 patients. Gastroenterol. Clin. Biol., 7, 605–609PubMedGoogle Scholar
  44. 44.
    Thistle, J. L. (1981). Medical treatment of gallstones. Pract. Gastroenterol., 5, 31–38Google Scholar

Copyright information

© MTP Press Limited 1984

Authors and Affiliations

  • R. H. Dowling

There are no affiliations available

Personalised recommendations