Long-term ursodeoxycholic acid therapy is associated with reduced risk of biliary pain and acute cholecystitis in patients with gallbladder stones: Acohort analysis

Whether ursodeoxycholic acid (UDCA) therapy alters the long-term clinical c ourse of gallstones (GS) without stone dissolution remains unknown. We aime d to clarify the relationship between long-term UDCA therapy and risks of b iliary pain or acute cholecystitis in GS patients. We also aimed to identif y factors affecting the natural course, and to explore a simple patient sel ection criteria for UDCA therapy. A cohort of 527 uncomplicated GS patients with or without UDCA (600 mg/d) followed for up to 18 years was analyzed. Patients who had frequent attacks or were complicated with cholecystitis we re converted to cholecystectomy. History and UDCA therapy were identified o n Cox analysis as 2 factors affecting the long-term clinical course. In pat ients without therapy, history was the only predictor of biliary pain among various patient or stone characteristics; biliary pain was rare in asympto matic patients, while frequent in symptomatic patients (P <.001). UDCA ther apy was associated with reduced risk for biliary pain in both symptomatic ( 62% vs. 92% in untreated patients at 10 years; P <.001; relative risk, 0.19 ; 95% CI, 0.10-0.34) and asymptomatic patients (6% vs. 12% in untreated pat ients at 10 years; P =.037; relative risk, 0.19; 95% CI, 0.04-0.91), Risk f or the conversion was also reduced in UDCA-treated symptomatic patients (26 % vs. 88% in untreated patients at 10 years, P <.001; relative risk, 0.08; 95% CI, 0.03-0.22), These effects were independent of stone dissolution, Th ree factors were identified on Cox analysis as affecting GS dissolution: ra diolucency, small size (<10 mm) of stones, and visualized gallbladder (GB) on cholecystogram, A selection criteria based on these appears to exhibit h igh sensitivity (74%) and specificity (95%) for dissolution. UDCA therapy m ight be considered in symptomatic patients fulfilling these criteria, and a lso in patients who have significant surgical risk, because the longterm th erapy is clearly associated with reduced risk of biliary pain and acute cho lecystitis.