Mr. Narkewicz et al., EFFECT OF URSODEOXYCHOLIC ACID THERAPY ON HEPATIC-FUNCTION IN CHILDREN WITH INTRAHEPATIC CHOLESTATIC LIVER-DISEASE, Journal of pediatric gastroenterology and nutrition, 26(1), 1998, pp. 49-55
Background: Ursodeoxycholic acid (UDCA) has been shown to improve prur
itus, alanine aminotransferase (ALT), and cholesterol levels in childr
en with intrahepatic cholestatic liver disease. However, the effect of
UDCA on quantitative tests of hepatic function in children is uncerta
in. Methods: A 2.5-year, open label, crossover study, was desired to d
etermine the effect of UDCA (15-20 mg/kg per day for 12 months, off fo
r 6 months, and on again for 12 months) on clinical symptoms, biochemi
cal test results, galactose and caffeine elimination half-lives (t(1/2
)), and quantitative hepatic scintigraphy in 13 subjects aged 13.1 +/-
2.1 years (10 of whom completed the entire study), with intrahepatic
cholestasis. Results: Pruritus improved with UDCA in the 6 patients wi
th pruritus on entry into the study. At 12 months, there was a signifi
cant decline in ALT, gamma-glutamyl transpeptidase, and plasma levels
of copper and manganese, with no further decline in these levels at 24
months. There were no changes in bilirubin or cholylglycine levels. A
fter therapy was discontinued at 12 months, UDCA was restarted within
1 month in 9 of 12 patients in response to a doubling of ALT (n = 6) o
r worsening pruritus (n = 3). Galactose t(1/2) increased after 12 mont
hs, with no further increases after 24 months of UDCA therapy, whereas
caffeine t(1/2), did not change. There were no significant changes in
hepatic scintigraphy throughout the study. Conclusions: These data su
ggest that although UDCA therapy improves pruritus and results in a re
duction in ALT and gamma-glutamyl transpeptidase, UDCA therapy did not
improve quantitative measures of hepatic function in children with in
trahepatic cholestasis.