Gallstone disease medical therapy: Difference between revisions
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Nonsurgical approaches are used only in special situations such as when a patient has a serious medical condition preventing surgery and only for cholesterol stones. Stones commonly recur within 5 years in patients treated nonsurgically. | Nonsurgical approaches are used only in special situations such as when a patient has a serious medical condition preventing surgery and only for cholesterol stones. Stones commonly recur within 5 years in patients treated nonsurgically. | ||
*'''Oral dissolution therapy | *'''Oral dissolution therapy''' Drugs made from bile acid are used to dissolve gallstones. The drugs ursodiol (Actigall) and chenodiol (Chenix) work best for small cholesterol stones. Months or years of treatment may be necessary before all the stones dissolve. Both drugs may cause mild diarrhea, and chenodiol may temporarily raise levels of blood cholesterol and the liver enzyme transaminase. | ||
*'''Contact dissolution therapy | *'''Contact dissolution therapy''' This experimental procedure involves injecting a drug directly into the gallbladder to dissolve cholesterol stones. The drug, methyl ter-butyl ether, can dissolve some stones in 1 to 3 days, but it causes irritation and some complications have been reported. The procedure is being tested in symptomatic patients with small stones. | ||
===Treatment of biliary colic=== | ===Treatment of biliary colic=== | ||
These attacks are intensely painful, similar to that of a [[kidney stone]] attack. | These attacks are intensely painful, similar to that of a [[kidney stone]] attack. Pain management is an important part of treating biliary colic. Treatment is often with [[NSAIDs]] such as [[ketorolac]] (Toradol) and [[diclofenac]] (Voltaren). [[Hyoscine butylbromide]] (Buscopan) is occasionally used but is less effective than analgesics.<ref>{{cite web |url=http://www.bestbets.org/bets/bet.php?id=882 |title=BestBets: Buscopan (hyoscine butylbromide) in biliary colic. |format= |work= |accessdate=}}</ref> | ||
Pain management is an important part of treating biliary colic. Treatment is often with [[NSAIDs]] such as [[ketorolac]] (Toradol) and [[diclofenac]] (Voltaren). [[Hyoscine butylbromide]] (Buscopan) is occasionally used but is less effective than analgesics.<ref>{{cite web |url=http://www.bestbets.org/bets/bet.php?id=882 |title=BestBets: Buscopan (hyoscine butylbromide) in biliary colic. |format= |work= |accessdate=}}</ref> | |||
===Contraindicated medications=== | ===Contraindicated medications=== | ||
Revision as of 14:05, 4 December 2017
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]
Overview
Patients with asymptomatic gallstones are usually not treated since the chances of complications developing in the future are low, however, patients with symptomatic gallstones can be treated medically, for example, with ursodeoxycholic acid or lithotripsy. However, the mainstay of treatment for gallstone disease is surgical cholecystectomy.
Medical therapy
Cholesterol gallstones can sometimes be dissolved by oral ursodeoxycholic acid. Gallstones may recur however, once the drug is stopped.
Nonsurgical approaches are used only in special situations such as when a patient has a serious medical condition preventing surgery and only for cholesterol stones. Stones commonly recur within 5 years in patients treated nonsurgically.
- Oral dissolution therapy Drugs made from bile acid are used to dissolve gallstones. The drugs ursodiol (Actigall) and chenodiol (Chenix) work best for small cholesterol stones. Months or years of treatment may be necessary before all the stones dissolve. Both drugs may cause mild diarrhea, and chenodiol may temporarily raise levels of blood cholesterol and the liver enzyme transaminase.
- Contact dissolution therapy This experimental procedure involves injecting a drug directly into the gallbladder to dissolve cholesterol stones. The drug, methyl ter-butyl ether, can dissolve some stones in 1 to 3 days, but it causes irritation and some complications have been reported. The procedure is being tested in symptomatic patients with small stones.
Treatment of biliary colic
These attacks are intensely painful, similar to that of a kidney stone attack. Pain management is an important part of treating biliary colic. Treatment is often with NSAIDs such as ketorolac (Toradol) and diclofenac (Voltaren). Hyoscine butylbromide (Buscopan) is occasionally used but is less effective than analgesics.[1]
Contraindicated medications
Gallstone is considered an absolute contraindication to the use of the following medications: