From the Guidelines
Ursodiol is not recommended as a primary treatment for inflammatory bowel disease (IBD), but it may be beneficial for IBD patients with primary sclerosing cholangitis (PSC) due to its chemopreventive effect against colorectal cancer (CRC). The use of ursodiol in IBD is mainly supported by its effectiveness in patients with ulcerative colitis (UC) who also have PSC, as stated in the study by 1. According to this study, there is strong evidence that ursodeoxycholic acid (UDCA) has a chemopreventive effect against CRC, particularly in patients with UC and PSC. However, the evidence is insufficient to determine whether UDCA also has chemopreventive activity in patients with UC who do not have PSC.
Some key points to consider when evaluating the use of ursodiol in IBD include:
- The study by 1 highlights the lack of prospective, randomized, controlled trials evaluating the utility of chemopreventive agents, including ursodiol, in decreasing the risk of CRC in patients with IBD.
- The same study notes that mesalamine compounds have been shown to have a chemopreventive effect in many studies, but the evidence for ursodiol is limited to its use in patients with UC and PSC.
- The typical dosage of ursodiol for PSC patients is 13-15 mg/kg/day, divided into two or three doses, as it helps reduce bile acid toxicity and promote bile flow, protecting liver cells and improving liver function tests.
In summary, while ursodiol may have a role in managing specific liver complications in IBD patients, such as PSC, it is not a primary treatment for the intestinal inflammation characteristic of IBD. Conventional treatments like aminosalicylates, corticosteroids, immunomodulators, or biologics are more appropriate for IBD management, and patients should work with a gastroenterologist to develop a tailored treatment plan.
From the Research
Ursodiol and IBD
- Ursodiol, also known as ursodeoxycholic acid (UDCA), has been studied for its potential benefits in treating inflammatory bowel disease (IBD) [ 2, 3,4,5,6 ].
- A study published in 2021 found that UDCA may be effective in normalizing hepatobiliary enzymes in a patient with primary sclerosing cholangitis and ulcerative colitis [ 2 ].
- Another study from 2008 found that UDCA therapy improved liver biochemistries in patients with small-duct primary sclerosing cholangitis, but had no effect on delaying disease progression [ 3 ].
Biochemical Improvements
- A 1990 study found that UDCA treatment led to significant improvements in liver biochemistries, including decreased levels of alkaline phosphatase, gamma-glutamyl transpeptidase, and alanine aminotransferases [ 4 ].
- A 2012 study found that high-dose UDCA did not prevent colorectal neoplasia in patients with primary sclerosing cholangitis and IBD [ 5 ].
Potential Therapeutic Target
- A 2019 review suggested that UDCA may have a role to play in the therapy of inflammatory bowel diseases due to its cytoprotective and anti-inflammatory actions [ 6 ].
- The review highlighted the growing evidence base from in vitro and in vivo models supporting the potential benefits of UDCA in treating IBD [ 6 ].