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Pericholangitis Medication

  • Author: Robert P Myers, MD, FRCPC; Chief Editor: BS Anand, MD  more...
 
Updated: Jun 22, 2016
 

Medication Summary

The goals of pharmacotherapy are to reduce morbidity and prevent complications. However, no effective medical treatment exists for pericholangitis.

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Gallstone Solubilizing Agents

Class Summary

Although not a proven effective treatment for pericholangitis, the gallstone dissolution agent ursodeoxycholic acid (UDCA) might have a role to play in the management of this disorder.

Ursodiol (Actigall, Urso)

 

UDCA (ursodiol), a naturally occurring hydrophilic bile acid, is an effective therapy for primary biliary cirrhosis (PBC), another chronic cholestatic liver disease. Several large trials have shown improvements in liver biochemistry and reductions in mortality and need for liver transplantation in patients with PBC.

Although UDCA's exact mechanism of action is unknown, the beneficial effect probably is related to its ability to reduce the concentration of hydrophobic bile acids in the bile acid pool. These bile acids have detergent actions on cholangiocellular and hepatocellular membranes, which likely contribute to hepatotoxicity in this disorder.

The evidence for UDCA's potential role in treating primary sclerosing cholangitis (PSC) is less convincing. The largest trial of UDCA for PSC to date randomly assigned 105 patients at the Mayo Clinic to receive either UDCA 13-15 mg/kg/day or placebo. Because the inclusion criteria of this trial required cholangiographic evidence of PSC, the results are not directly applicable to patients with pericholangitis.

Despite biochemical improvement in some patients treated with UDCA, there was no significant difference in clinical outcomes after follow-up periods as long as 6 years. Despite the lack of long-term benefit observed in this study, many continue to prescribe UDCA to patients with PSC because of the improvements in liver biochemistry that it brings about. The role of higher doses of UDCA (as high as 30 mg/kg/day) is currently being evaluated in large controlled trials.

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Contributor Information and Disclosures
Author

Robert P Myers, MD, FRCPC Assistant Professor, Director, Viral Hepatitis Clinic, Division of Gastroenterology, Department of Medicine, University of Calgary Faculty of Medicine, Canada

Robert P Myers, MD, FRCPC is a member of the following medical societies: American Association for the Study of Liver Diseases, Royal College of Physicians and Surgeons of Canada, Canadian Association of Gastroenterology

Disclosure: Nothing to disclose.

Coauthor(s)

Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR Consultant Radiologist and Honorary Professor, North Manchester General Hospital Pennine Acute NHS Trust, UK

Ali Nawaz Khan, MBBS, FRCS, FRCP, FRCR is a member of the following medical societies: American Association for the Advancement of Science, American Institute of Ultrasound in Medicine, British Medical Association, Royal College of Physicians and Surgeons of the United States, British Society of Interventional Radiology, Royal College of Physicians, Royal College of Radiologists, Royal College of Surgeons of England

Disclosure: Nothing to disclose.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Additional Contributors

Julian Katz, MD Clinical Professor of Medicine, Drexel University College of Medicine

Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law, Medicine & Ethics, American Trauma Society, Association of American Medical Colleges, Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Acknowledgements

Tushar Patel, MB, ChB Professor of Medicine, Ohio State University Medical Center

Tushar Patel, MB, ChB is a member of the following medical societies: American Association for the Study of Liver Diseases and American Gastroenterological Association

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Noel Williams, MD Professor Emeritus, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Professor, Department of Internal Medicine, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada

Noel Williams, MD is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

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