Gallstone disease medical therapy: Difference between revisions
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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 surgically especially with the introduction of laparoscopic cholecystectomy. <ref name="pmid8054014">{{cite journal |vauthors=Darzi A, Geraghty JG, Williams NN, Sheehan SS, Tanner AN, Keane FB |title=The pros and cons of laparoscopic cholecystectomy and extracorporeal shock wave lithotripsy in the management of gallstone disease |journal=Ann R Coll Surg Engl |volume=76 |issue=1 |pages=42–6 |year=1994 |pmid=8054014 |pmc=2502162 |doi= |url=}}</ref><ref name="pmid9200309">{{cite journal |vauthors=Portincasa P, van de Meeberg P, van Erpecum KJ, Palasciano G, VanBerge-Henegouwen GP |title=An update on the pathogenesis and treatment of cholesterol gallstones |journal=Scand. J. Gastroenterol. Suppl. |volume=223 |issue= |pages=60–9 |year=1997 |pmid=9200309 |doi= |url=}}</ref> | 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 surgically especially with the introduction of laparoscopic cholecystectomy. <ref name="pmid8054014">{{cite journal |vauthors=Darzi A, Geraghty JG, Williams NN, Sheehan SS, Tanner AN, Keane FB |title=The pros and cons of laparoscopic cholecystectomy and extracorporeal shock wave lithotripsy in the management of gallstone disease |journal=Ann R Coll Surg Engl |volume=76 |issue=1 |pages=42–6 |year=1994 |pmid=8054014 |pmc=2502162 |doi= |url=}}</ref><ref name="pmid9200309">{{cite journal |vauthors=Portincasa P, van de Meeberg P, van Erpecum KJ, Palasciano G, VanBerge-Henegouwen GP |title=An update on the pathogenesis and treatment of cholesterol gallstones |journal=Scand. J. Gastroenterol. Suppl. |volume=223 |issue= |pages=60–9 |year=1997 |pmid=9200309 |doi= |url=}}</ref> | ||
== Medical therapy == | == Medical therapy == | ||
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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 surgically especially with the introduction of laparoscopic cholecystectomy. [1][2]
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.[3][4][5]
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.[6][7][8][9]
Contraindicated medications
Gallstone is considered an absolute contraindication to the use of the following medications:
References
- ↑ Darzi A, Geraghty JG, Williams NN, Sheehan SS, Tanner AN, Keane FB (1994). "The pros and cons of laparoscopic cholecystectomy and extracorporeal shock wave lithotripsy in the management of gallstone disease". Ann R Coll Surg Engl. 76 (1): 42–6. PMC 2502162. PMID 8054014.
- ↑ Portincasa P, van de Meeberg P, van Erpecum KJ, Palasciano G, VanBerge-Henegouwen GP (1997). "An update on the pathogenesis and treatment of cholesterol gallstones". Scand. J. Gastroenterol. Suppl. 223: 60–9. PMID 9200309.
- ↑ Ward A, Brogden RN, Heel RC, Speight TM, Avery GS (1984). "Ursodeoxycholic acid: a review of its pharmacological properties and therapeutic efficacy". Drugs. 27 (2): 95–131. PMID 6365507.
- ↑ Bachrach WH, Hofmann AF (1982). "Ursodeoxycholic acid in the treatment of cholesterol cholelithiasis. part I". Dig. Dis. Sci. 27 (8): 737–61. PMID 7094795.
- ↑ Bachrach WH, Hofmann AF (1982). "Ursodeoxycholic acid in the treatment of cholesterol cholelithiasis. Part II". Dig. Dis. Sci. 27 (9): 833–56. PMID 7049627.
- ↑ "BestBets: Buscopan (hyoscine butylbromide) in biliary colic".
- ↑ Colli A, Conte D, Valle SD, Sciola V, Fraquelli M (2012). "Meta-analysis: nonsteroidal anti-inflammatory drugs in biliary colic". Aliment. Pharmacol. Ther. 35 (12): 1370–8. doi:10.1111/j.1365-2036.2012.05115.x. PMID 22540869.
- ↑ Henderson SO, Swadron S, Newton E (2002). "Comparison of intravenous ketorolac and meperidine in the treatment of biliary colic". J Emerg Med. 23 (3): 237–41. PMID 12426013.
- ↑ Akriviadis EA, Hatzigavriel M, Kapnias D, Kirimlidis J, Markantas A, Garyfallos A (1997). "Treatment of biliary colic with diclofenac: a randomized, double-blind, placebo-controlled study". Gastroenterology. 113 (1): 225–31. PMID 9207282.