Gallstones are hardened bits of bile, a fluid that helps the body digest dietary fat. Most people with gallstones have no symptoms and do not require treatment. If gallstones cause abdominal pain or present a risk for complications, the preferred treatment is usually gallbladder removal. This is commonly performed using a minimally-invasive procedure called a laparoscopic cholecystectomy. People who want to avoid surgery or cannot safely undergo a surgical procedure may be candidates for nonsurgical management with medication intended to dissolve gallstones.
Medications given by mouth to dissolve gallstones are appropriate for approximately 30 percent of people with gallstone-related disease. These medications, called chenodeoxycholic acid and ursodeoxycholic acid, are made of bile acids. The composition of gallstones affects the success rate with these medications. People with small cholesterol gallstones have the greatest chance of success with dissolution therapy. Those unlikely to benefit are people with large cholesterol stones, pigment stones composed of bilirubin and obese patients. Treatment can take several years and gallstones may recur.
Ursodeoxycholic acid (ursodiol, Actigall) dissolves up to 80 percent of very small gallstones within six months. Treatment with this medication is less successful when the stones are large. Even if treatment is successful, as many as 50 percent of patients experience recurrent gallstones. Ursodiol is not an appropriate treatment option for people with calcified cholesterol or pigment gallstones.
Possible side effects of ursodiol include diarrhea, constipation, upset stomach, indigestion, dizziness, vomiting, cough, runny nose, sore throat, back pain, joint or muscle pain, hair loss and frequent urination or painful urination.
Chenodeoxycholic acid (Chenodiol, Chenodal) is a bile acid that gradually dissolves cholesterol gallstones in certain patients, especially those with small stones composed primarily of cholesterol. Even when the medication is successful in dissolving gallstones, an estimated 50 percent of patients have a recurrence within 5 years.
Chenodiol should not be given to pregnant women or people with liver disease, gallbladder obstruction, gallstone complications or large, noncholesterol gallstones. Side effects may include diarrhea, liver inflammation, heartburn, decreased appetite, nausea, elevated blood cholesterol and a decreased white blood cell count.
Contact Dissolution Therapy
Contact dissolution of gallstones is experimental and is not widely accepted or available. The procedure involves injecting a chemical solvent directly into the gallbladder. The surgeon inserts a thin tube into the gallbladder and connects a pump that delivers small amounts of solvent directly into the organ over a period of hours or days. The procedure can reduce cholesterol stones rapidly, but the risk of complications is high due to the toxic nature of chemical solvents.