Ursodeoxycholic acid (UDCA), also referred to by its generic name ursodiol, is a naturally occurring bile acid found in small quantities in human bile. Its therapeutic use stems from its unique hydrophilic properties, which make it less toxic than other naturally occurring bile acids. Administered orally, it becomes a major component of the bile acid pool, providing protection to liver cells and helping to normalize bile composition. UDCA is a cornerstone treatment for certain cholestatic liver diseases and offers a non-surgical option for specific patients with gallstones.
Treating Primary Biliary Cholangitis (PBC)
Primary Biliary Cholangitis (PBC), formerly known as primary biliary cirrhosis, is a chronic autoimmune liver disease characterized by progressive destruction of small bile ducts. UDCA is the first-line treatment for PBC, improving liver function and delaying disease progression. UDCA works by improving liver biochemistries, protecting liver cells, and having immunomodulatory effects.
Dissolving and Preventing Gallstones
UDCA is used to dissolve cholesterol gallstones in patients unsuitable for surgery, specifically non-calcified, small stones. This treatment can take months to years, with a potential for recurrence. It is crucial that the gallstones are cholesterol-based, radiolucent, and the cystic duct is unblocked. Regular ultrasound monitoring is necessary. UDCA also prevents gallstones in individuals undergoing rapid weight loss.
Other Medical Applications
UDCA is also used off-label for other conditions. Its use in Primary Sclerosing Cholangitis (PSC) is debated due to mixed trial results. It is often used for Intrahepatic Cholestasis of Pregnancy (ICP) to relieve symptoms, though its impact on outcomes is debated. Some research suggests it can help with bile reflux gastritis and cystic fibrosis-related liver disease.
How Ursodeoxycholic Acid Works
UDCA's effects result from multiple mechanisms, including modifying the bile acid pool, reducing cholesterol absorption and secretion, protecting liver cells, stimulating bile flow, and inhibiting cell death.
Comparing UDCA and Cholecystectomy for Gallstones
| Feature | Ursodeoxycholic Acid (UDCA) | Cholecystectomy (Surgical Removal) |
|---|---|---|
| Invasiveness | Non-invasive (oral medication) | Invasive (surgical procedure) |
| Candidate Selection | Limited to small, non-calcified, radiolucent cholesterol stones in a functioning gallbladder | Appropriate for all types and sizes of gallstones |
| Effectiveness | Moderate success rate (30-60%) for dissolving stones, with high recurrence (up to 50%) | Very high success rate (removes the gallbladder and stones permanently) |
| Treatment Duration | Long-term, often 6 months to 2 years, with ongoing risk of recurrence | One-time procedure with a relatively short recovery period |
| Side Effects | Generally mild, including diarrhea, nausea, headache | Surgical risks, anesthesia complications, and potential for post-operative pain |
| Patient Suitability | Non-surgical candidates due to age, comorbidities, or patient refusal | Suitable for patients who can tolerate surgery or for urgent cases like complications (e.g., severe cholecystitis, pancreatitis) |
Potential Side Effects and Safety Considerations
UDCA can cause side effects, most commonly gastrointestinal issues like diarrhea and nausea. Other side effects include headache and back pain. Serious effects are rare but require medical attention. UDCA is not suitable for patients with complete biliary obstruction. Those with advanced liver disease need careful management. UDCA can interact with certain medications like bile acid sequestrants and antacids.
Conclusion
Ursodeoxycholic acid (UDCA) is a key medication primarily used for Primary Biliary Cholangitis (PBC) and dissolving cholesterol gallstones in certain patients. It works by altering bile composition and protecting liver cells. While it slows disease progression for chronic conditions like PBC, it's not a cure. Medical supervision is essential for appropriate use, monitoring, and managing side effects. Other treatments, including surgery, may be needed for specific cases or advanced disease.
For more detailed information, consult the {Link: NCBI Bookshelf https://www.ncbi.nlm.nih.gov/sites/books/NBK545303/}.
