From the Guidelines
The treatment for gallbladder stones in adult males depends on stone size and symptoms, with oral dissolution therapy with ursodeoxycholic acid (UDCA) considered for small stones (<5-10mm) and surgical removal (laparoscopic cholecystectomy) for medium to large stones (>10mm) or calcified stones. For small stones that are cholesterol-based and in a functioning gallbladder, UDCA may be attempted at a dose of 8-10mg/kg/day, divided into two doses, for 6-24 months 1. Complete dissolution occurs in only 30-40% of carefully selected patients, and recurrence is common after stopping treatment. UDCA works by decreasing cholesterol secretion into bile and solubilizing cholesterol from stones.
When using UDCA, adjunctive medications may include:
- Pain relievers like acetaminophen or NSAIDs for discomfort
- Antispasmodics such as hyoscine butylbromide for biliary colic Some practitioners combine UDCA with chenodeoxycholic acid for potentially improved dissolution rates, though this combination may cause more gastrointestinal side effects 1. Patients should maintain a low-fat diet during medical therapy to reduce biliary colic episodes and improve UDCA effectiveness. Regular ultrasound monitoring every 6 months is recommended to assess stone dissolution progress during medical therapy 1.
For medium to large stones (>10mm), multiple stones, or calcified stones, UDCA is generally ineffective, and surgical removal (laparoscopic cholecystectomy) is the standard treatment 1. The choice of treatment should be based on the patient's treatment goals and attitudes, as well as the natural history of the disease 1.
From the FDA Drug Label
Ursodiol suppresses hepatic synthesis and secretion of cholesterol, and also inhibits intestinal absorption of cholesterol With repeated dosing, bile ursodeoxycholic acid concentrations reach a steady-state in about 3 weeks An Ursodiol dose of about 8-10 mg/kg/day appeared to be the best dose With an Ursodiol dose of about 10 mg/kg/day, complete stone dissolution can be anticipated in about 30% of unselected patients with uncalcified gallstones < 20 mm in maximal diameter treated for up to 2 years The chance of gallstone dissolution is increased up to 50% in patients with floating or floatable stones (i.e., those with high cholesterol content), and is inversely related to stone size for those < 20 mm in maximal diameter. Complete dissolution was observed in 81% of patients with stones up to 5 mm in diameter. The recommended dose for Ursodiol treatment of radiolucent gallbladder stones is 8 - 10 mg/kg/day given in 2 or 3 divided doses. Ultrasound images of the gallbladder should be obtained at 6-month intervals for the first year of Ursodiol therapy to monitor gallstone response
The treatment guideline for different sizes of gallbladder stones in adult males using Ursodeoxycholic acid (UDCA) tablets is as follows:
- For stones < 5 mm in diameter, complete dissolution can be anticipated in about 81% of patients.
- For stones < 20 mm in maximal diameter, complete stone dissolution can be anticipated in about 30% of unselected patients treated for up to 2 years.
- The recommended dose for UDCA treatment of radiolucent gallbladder stones is 8-10 mg/kg/day given in 2 or 3 divided doses.
- The duration of treatment is up to 2 years, with ultrasound images of the gallbladder obtained at 6-month intervals for the first year to monitor gallstone response. Other medications that may be used along with UDCA include:
- Chenodiol, which is more efficiently 7-dehydroxylated than ursodiol, but has a higher risk of liver injury.
- Note that the FDA label does not provide information on other medications used in combination with UDCA for the treatment of gallstones. 2, 2, 2
From the Research
Treatment Guidelines for Gallbladder Stones
The treatment guidelines for gallbladder stones in adult males vary depending on the size of the stones.
- For small stones (less than 5 mm in diameter), ursodeoxycholic acid (UDCA) tablets may be prescribed as a non-surgical treatment option 3, 4.
- For medium-sized stones (5-20 mm in diameter), UDCA tablets may be used in combination with extracorporeal shock-wave lithotripsy (ESWL) 3, 4.
- For large stones (greater than 20 mm in diameter), surgery may be the recommended treatment option.
Ursodeoxycholic Acid (UDCA) Tablets
UDCA tablets are used to dissolve gallstones by reducing the production of cholesterol in the liver and increasing the production of bile acids 5, 6.
- The typical dosage of UDCA is 10 mg/kg/day, taken orally for several months or even years 4, 6.
- The duration of treatment with UDCA tablets can vary from 6 months to 2 years or more, depending on the size and number of stones 3, 4.
Other Medications Along with UDCA
Other medications that may be used along with UDCA include:
- Chenodeoxycholic acid (CDCA), which is another bile acid that can help dissolve gallstones 3, 4.
- Anti-spasmodic medications, which can help relieve symptoms of biliary colic 4.
- Pain relief medications, which can help manage pain associated with gallstones 4.
Important Considerations
It is essential to note that UDCA tablets are not effective for all types of gallstones, and their use should be carefully considered on a case-by-case basis 5, 7.