From the Guidelines
Ursodeoxycholic acid (UDCA) is the primary medication used to treat gallbladder sludge, with a recommended dosage of 13-15 mg/kg/d, as it has been shown to decrease cholesterol production in the liver and dissolve cholesterol in bile, thereby preventing sludge formation and potentially dissolving existing sludge 1. The treatment of gallbladder sludge typically involves a combination of medication and dietary changes.
- The medication of choice is ursodeoxycholic acid (UDCA), which works by decreasing cholesterol production in the liver and dissolving cholesterol in bile.
- The usual dosage of UDCA is 13-15 mg/kg/d, as recommended by the EASL clinical practice guidelines 1.
- In addition to medication, dietary changes can help manage gallbladder sludge, including:
- Reducing fat intake
- Maintaining a healthy weight
- Eating regular meals
- Staying well-hydrated
- Adding more fiber to the diet It's also important to note that maintaining or resuming oral nutrition can help prevent gallbladder sludge, especially in patients on parenteral nutrition (PN) 1. If symptoms are severe or persistent despite medication therapy, surgical removal of the gallbladder (cholecystectomy) may be recommended, especially in cases of biliary complications 1. Regular follow-up with a healthcare provider is essential to monitor progress and adjust treatment as needed, as gallbladder sludge can sometimes progress to gallstones or resolve on its own.
From the Research
Medications for Treating Sludge in the Gallbladder
- Ursodeoxycholic acid (ursodiol) is a medication that has been shown to be effective in dissolving gallstones and treating biliary sludge 2, 3, 4, 5, 6.
- The medication works by reducing the amount of cholesterol in the bile, making it less likely for stones to form 3, 5.
- Ursodiol has been shown to be safe and effective in treating patients with radiolucent gallstones and functioning gallbladders 2, 4.
- The optimal dose of ursodiol for treating gallstones and biliary sludge is typically 600 mg per day, divided into two doses 6.
- Studies have shown that ursodiol can be effective in treating patients with persistent biliary sludge, with complete dissolution of sludge observed in 100% of patients in one study 6.
- Minor adverse effects of ursodiol include acidism and diarrhea, but these are rare and typically do not require discontinuation of treatment 3, 6.
Patient Selection and Treatment Criteria
- Patients with small, radiolucent gallstones and functioning gallbladders are the most suitable candidates for treatment with ursodiol 2, 4.
- Patients with calcified or pigment stones are not likely to respond to treatment with ursodiol 3.
- Patients with severe acute or chronic intrahepatic cholestasis, or those who are pregnant or likely to become pregnant, should not be treated with ursodiol 2.
- Screening tests, including liver function tests, sonographic evaluation of the gallbladder and biliary tree, and oral cholecystogram, should be performed before starting treatment with ursodiol 2.