Cholesterol stones, a type of gallstone, can be treated non-surgically with oral dissolution therapy, said Dr. Val F. Neri, a gastroenterologist at San Pablo Colleges Medical Center and chief of clinics at San Pablo Doctors Hospital.
“In oral dissolution therapy, we are reversing the process that predisposes the patient to cholesterol gallstones,” he said in a July 15 webinar organized by the University of the Philippines (UP) Manila. “If you can make the [body’s] environment less conducive to stone formation, you might be able to dissolve the stone.”
To be eligible for this treatment, a patient should be mildly symptomatic and without complications such as sepsis or acute pancreatitis (or the sudden inflammation of the pancreas); should have a functioning gallbladder; and should have stones that are radiolucent (or relatively penetrable by X-rays) ranging 6–10 millimeters in size.
Cholesterol gallstones, which are made of 50–100% mostly hardened cholesterol, are common in America and Europe and are associated with factors such as obesity.
Meanwhile, black pigment gallstones, which are devoid of cholesterol, are common in Asia and are associated with factors such as hemolytic disorders. Brown pigment gallstones are made of calcium fatty acids, are also common in Asia, and are associated with factors such as inflammation.
Oral dissolution therapy, Dr. Neri emphasized, can only be used with cholesterol gallstones. “The patient should have a cholesterol gallstone, and not a pigment [one]. It’s unfortunate that most Asians, including Filipinos, have pigment stones,” he said.
Since gallstones develop over a long period of time, dissolving them also requires treatment from between six months to two years, he added.
Ursodeoxycholic acid (UCDA) is the agent of choice for this treatment.
“A caveat of this mode of therapy is that … approximately 50% will have a recurrence after five years of the [gallstones’] dissolution,” he said. “The reason is the persistence of risk factors for the formation of gallstone.”
Non-modifiable risk factors include age (the incidence for gallstones increases as one gets older) and gender (the female hormone estrogen increases the cholesterol saturation of bile); while modifiable ones include a Western-style diet (which is high in refined carbohydrates and low in fiber) and rapid weight loss.
Dr. Neri said only those with symptoms need to be treated. Biliary colic — pain in the upper-right that occurs after a meal and lasts less than six hours — is the typical symptom.
Surgical treatment of asymptomatic gallstones without “medically complicating” diseases is discouraged because the “risk of complication arising from interventions is higher than the risk of the symptomatic disease,” he added. — Patricia B. Mirasol