- Author: Robert P Myers, MD, FRCPC; Chief Editor: BS Anand, MD more...
The goals of pharmacotherapy are to reduce morbidity and prevent complications. However, no effective medical treatment exists for pericholangitis.
Gallstone Solubilizing Agents
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.
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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