A COMBINATION THERAPY WITH SIMVASTATIN AND URSODEOXYCHOLIC ACID IS MORE EFFECTIVE FOR CHOLESTEROL GALLSTONE DISSOLUTION THAN IS URSODEOXYCHOLIC ACID MONOTHERAPY

Inhibitors of 3-hydroxy,3-methylglutaryl coenzyme A (HMG-CoA) reductas e have been reported to decrease the cholesterol saturation index (CSI ) in duodenal bile in humans and to prevent formation of cholesterol g allstones in animal studies. We performed a prospective study to evalu ate the role of HMG-CoA reductase inhibitors as gallstone-dissolving a gents. Fifty patients with radiolucent gallstones in a gallbladder opa cifying at drip infusion cholecystography were treated with either 10 mg/day simvastatin plus 600 mg/day ursodeoxycholic acid (group 1, n = 26) or 600 mg/day ursodeoxycholic acid alone (group 2, n = 24) for 12 months. The ratio of solitary to multiple gallstone cases was 21:29. P lasma lipid levels were assessed and ultrasonographic examination of t he gallbladder was performed at baseline and at 3-month intervals duri ng treatment. Duodenal bile sampling was performed in five patients in each group at baseline and after 12 months of treatment. Plasma chole sterol decreased significantly in group 1 but not in group 2. In solit ary gallstone cases, no significant difference in dissolution rates wa s observed between groups 1 (3 of 9, 33%) and 2 (4 of 12, 33%). In con trast, the dissolution rate in multiple gallstone cases was significan tly higher in group 1 (12 of 17, 71%) than in group 2 (3 of 12, 25%) ( p < 0.01). Bile cholesterol saturation index was significantly decreas ed (p < 0.01) but did not significantly differ between the two groups. These results suggest that combination therapy with simvastatin and u rsodeoxycholic acid is more effective for cholesterol gallstone dissol ution than ursodeoxycholic acid monotherapy in patients with multiple gallstones.