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March 20, 1978

Chenotherapy for Gallstone Dissolution: II. Induced Changes in Bile Composition and Gallstone Response

Author Affiliations

From the Gastroenterology Unit, Mayo Clinic and Foundation, Rochester, Minn (Drs Hofmann and Thistle and Ms Yu); and the Argonne National Laboratory, Energy Research and Development Administration, Argonne, III (Dr Klein and Ms Szczepanik). Dr Hofmann is now with the Department of Medicine, University of California, San Diego, and Ms Yu is with the Department of Medicine, Stanford University, Stanford, Calif.

JAMA. 1978;239(12):1138-1144. doi:10.1001/jama.1978.03280390034017

Changes in bile saturation and biliary bile acid composition in patients with gallstones who received chenodeoxycholic ("chenic") acid, cholic acid, or placebo were measured. Chenodeoxycholic induced bile desaturation; this effect was attributable solely to a decrease in the proportion of cholesterol. By gas chromatography, chenodeoxycholic acid increased substantially in the biliary bile acids of patients receiving it, and by mass spectrometry, no unusual bile acids were detected in appreciable amounts. Changes in bile saturation and biliary bile acid composition were then related to chenodeoxycholic acid dosage, and all of these variables were, in turn, related to gallstone response.

In general, patients whose gallstones dissolved ingested a higher dose of chenodeoxycholic acid or had bile that contained a higher proportion of this acid and it was more unsaturated, but there were many exceptions, casting doubt on the value of a single analysis of fasting-state bile for predicting gallstone dissolutions.

The major factor influencing response, provided dosage is adequate, appears to be gallstone type. Nonetheless, the proportion of chenodeoxycholic acid in biliary bile acids can probably be used to infer patient compliance.

(JAMA 239:1138-1144, 1978)