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Dissolving gallstones with medications

, medical expert
Last reviewed: 06.07.2025
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It is believed that the dissolution of gallstones by removing cholesterol contained in the gallstones as a result of the use of bile acid preparations occurs through micellar dilution, formation of a liquid crystalline form, or both processes simultaneously.

Micellar dilution appears to be the main mechanism of gallstone dissolution by chenodeoxycholic acid preparations, whereas liquid crystalline phase formation plays an important role with ursodeoxycholic acid preparations.

The rate of dissolution of gallstones depends largely on the content of bile acids, the surface to volume ratio of the stones (therefore, multiple small stones dissolve faster) and the movement of bile, i.e. the rate of emptying of the gallbladder (kinetic factor).

During dissolution, insoluble material may gradually accumulate on the surface of the stones, which slows down the dissolution process. In these cases, some authors consider additional use of lithotripsy to be appropriate.

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Dissolution of gallstones with ursodeoxycholic acid

To date, clear indications and criteria for selecting patients for litholytic therapy with ursodeoxycholic acid (UDCA, URSOSAN) have been developed, compliance with which increases its effectiveness to 80-100%. It should be noted that no more than 20% of all patients with cholelithiasis meet these criteria. The main conditions for successful dissolution of gallstones:

  • cholesterol (radiographically negative stones);
  • the size of the stones is no more than 10 mm;
  • patency of the extrahepatic bile ducts and preserved or slightly changed function of the gallbladder (concentration and contractility);
  • the gallbladder is filled with stones to no more than 25% of its volume on an empty stomach.

These conditions require mandatory clarification using ultrasound:

  • Homogeneous, low-echoic structure of the calculus (if there is an acoustic shadow from the anterior surface of the stone or above its middle, litholytic therapy is not indicated).
  • Round or oval shape of the stone (patients with pyramidal or flat configuration of stones are excluded).
  • The surface of the stone is close to smooth or in the form of a “mulberry”.
  • A faint, poorly visible acoustic shadow behind the calculus,
  • Slow fall of the stone after changing the patient's body position
  • The size of the calculus is no more than 10 mm.

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Dissolution of gallstones with Ursosan

One of the most effective modern drugs for litholytic therapy is URSOSAN (UDCA). Here is the scheme of its use: The average dosage of the drug for dissolving gallstones is 10 mg / kg of body weight. Usually, the daily dose of the drug is taken once in the evening, which is associated with the daily rhythm of cholesterol synthesis, the peak occurs at night, as well as with the period of maximum functional rest of the gallbladder. The duration of taking the drug until the stones are completely dissolved and at least three more months to prevent relapse of stone formation. Thus, the total duration of treatment is 6-12 months or more.

It is believed that the absence of a decrease in the size of stones within 6 months, as well as their complete dissolution within 2 years, is the basis for stopping litholytic therapy.

If the treatment is successfully performed and completed, the doctor and the patient should not become complacent, since 10% of patients have a risk of relapse during the first year, so to prevent relapses, such patients should undergo ultrasound twice a year. Meanwhile, it is well known that the reduction in the size and number of stones, which are considered an indicator of effectiveness, depends not only on the dissolving effect of the drugs, but also on the experience of the ultrasound specialist assessing the effectiveness of the therapy, the type of device, the patient's position at the time of the examination, etc. Despite the fact that litholytic therapy is expensive, dissolving gallstones with drugs allows you to preserve a functioning gallbladder.

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