What is ursodiol and how does it help dissolve gallstones? Learn the key facts about this medication, its uses, precautions, and potential side effects.

Understanding Ursodiol: The Gallstone Dissolving Agent

Ursodiol, also known as ursodeoxycholic acid, is a medication primarily used to dissolve gallstones in individuals who either do not want or cannot undergo surgery to remove them. This medication belongs to a class of drugs called gallstone dissolution agents, and it works by decreasing the production of cholesterol and dissolving the cholesterol present in bile, thereby preventing stone formation.

Approved Uses of Ursodiol

Ursodiol has several approved uses, including:

• Dissolving gallstones in individuals who do not wish to undergo surgery or are unable to have the procedure.
• Preventing the formation of gallstones in overweight individuals who are losing weight rapidly.
• Treating primary biliary cholangitis (PBC), an autoimmune liver disease that was previously known as primary biliary cirrhosis.

How to Take Ursodiol Properly

Ursodiol comes in the form of capsules and tablets, which are typically taken two or three times a day with or without food. If you are taking the tablets to treat primary biliary cholangitis, they are usually taken two or four times a day with food. It is important to follow the directions on your prescription label carefully and to ask your doctor or pharmacist if you have any questions about how to take the medication.

Potential Side Effects of Ursodiol

Like any medication, ursodiol can cause side effects. Some common side effects include diarrhea, nausea, and abdominal pain. It is important to report any side effects to your doctor, as they may need to adjust your dosage or switch you to a different medication.

Precautions and Interactions

Before taking ursodiol, it is important to inform your doctor and pharmacist if you have any allergies or if you are taking any other medications, including over-the-counter drugs, vitamins, or herbal supplements. Certain medications, such as antacids containing aluminum, may interact with ursodiol and should be discussed with your healthcare provider.

Monitoring and Continued Use

Ursodiol may take several months to have a noticeable effect, and it is important to continue taking the medication as prescribed, even if you feel well. If you are taking ursodiol to dissolve gallstones, you may need to take it for up to two years. However, it is important to note that even if the gallstones do dissolve, they may reform within five years after successful treatment with ursodiol.

Does ursodiol have any special storage or disposal requirements?

Ursodiol does have some special storage and disposal requirements. If you need to break the tablet for your specific dose, place the tablet on a flat surface with the scored section on the top. Hold the tablet with your thumbs close to the scored part and apply gentle pressure to snap the tablet into two parts. Swallow the half tablet with water; do not chew the half tablet. Because the tablet has a strong bitter taste, store the other tablet half in a separate container from the whole tablets. Use the stored half tablet within 28 days.

What should you do if you forget to take a dose of ursodiol?

If you forget to take a dose of ursodiol, take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

When Should You Avoid Ursodiol?

There are certain situations when you should avoid taking ursodiol. Your doctor will likely tell you not to take ursodiol if you have a type of gallstone that will not dissolve or if surgery is a better choice for your condition. Additionally, your doctor may advise against ursodiol if you have bile duct blockage or certain other gastrointestinal or liver conditions.

Can ursodiol be used during pregnancy or breastfeeding?

If you are pregnant, plan to become pregnant, or are breastfeeding, it is important to inform your doctor. They can provide guidance on the appropriate use of ursodiol during these times.

In summary, ursodiol is a proven and effective medication for dissolving gallstones and preventing their formation in certain individuals. By understanding the proper use, precautions, and potential side effects of ursodiol, you can work closely with your healthcare provider to determine if this treatment option is right for you.

Ursodiol: MedlinePlus Drug Information

pronounced as (er’ soe dye ol)

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Ursodiol is used to dissolve gallstones in people who do not want surgery or cannot have surgery to remove gallstones. Ursodiol is also used to prevent the formation of gallstones in overweight people who are losing weight very quickly. Ursodiol is used to treat people with primary biliary cholangitis (PBC; formerly known as a primary biliary cirrhosis; an autoimmune liver disease). Ursodiol is in a class of medications called gallstone dissolution agents. It works by decreasing the production of cholesterol and by dissolving the cholesterol in bile to prevent stone formation and by decreasing toxic levels of bile acids that accumulate in primary biliary cirrhosis.

Ursodiol comes as a capsule and as a tablet to take by mouth. It is usually taken two or three times a day with or without food to treat gallstones and two times a day to prevent gallstones in people who are losing weight quickly. If you are taking the tablets to treat primary biliary cholangitis, they are usually taken 2 or 4 times a day with food. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take ursodiol exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

If you need to break the tablet for your specific dose, place the tablet on a flat surface with the scored section on the top. Hold the tablet with your thumbs close to the scored part and apply gentle pressure to snap the tablet into two parts. Swallow the half tablet with water; do not chew the half tablet. Because the tablet has a strong bitter taste, store the other tablet half in a separate container from the whole tablets. Use the stored half tablet within 28 days. If you have any questions, your doctor or pharmacist will tell you how to break the tablets and how you should take and store them.

This medication must be taken for months to have an effect. If you are taking ursodiol capsules to dissolve gall stones, you may need to take ursodiol for up to 2 years. Your gallstones may not completely dissolve, and even if your gallstones do dissolve you may have gallstones again within 5 years after successful treatment with ursodiol. Continue to take ursodiol even if you feel well. Do not stop taking ursodiol without talking to your doctor.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Before taking ursodiol,

• tell your doctor and pharmacist if you are allergic to ursodiol, bile acids, or any other medications, or any of the ingredients in ursodiol tablets and capsules. Ask your pharmacist for a list of the ingredients.
• tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• The following nonprescription or herbal products may interact with ursodiol: antacids that contain aluminum. Be sure to let your doctor and pharmacist know that you are taking these medications before you start taking ursodiol. Do not start any of these medications while taking ursodiol without discussing it with your healthcare provider.
• tell your doctor if you have bile duct blockage. Your doctor will probably tell you not to take ursodiol. Your doctor also will probably tell you not to take ursodiol if you have a type of gallstone that will not dissolve or if surgery is a better choice for your condition.
• tell your doctor if you have had gastrointestinal surgery. Also, tell your doctor if you have or have ever had variceal bleeding (bleeding in the esophagus or stomach), Crohn’s disease (a condition in which the body attacks the lining of the digestive tract, causing pain, diarrhea, weight loss, and fever), or liver disease.
• tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking ursodiol, call your doctor.

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

Ursodiol may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• dizziness
• headache
• cough, fever, sore throat, runny nose, or other signs of infection
• frequent urination or pain when you urinate
• muscle pain
• hair loss

Some side effects can be serious.

If you experience any of these symptoms, call your doctor immediately or get emergency medical treatment:

• indigestion
• stomach pain
• nausea
• vomiting
• diarrhea
• constipation
• hives; rash; itching; swelling of the face, eyes, mouth, throat, tongue, lips, hands, feet, ankles, or lower legs; or difficulty breathing or swallowing

Ursodiol may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom).

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can’t be awakened, immediately call emergency services at 911.

Symptoms of overdose may include the following:

• diarrhea

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How to Get Rid of Gallstones Naturally: 9 Treatments to Try

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Doctors typically recommend medication or surgery to treat gallstones. But certain dietary choices may help prevent gallstones from forming.

Gallstones are hard deposits that form in your gallbladder. There are two types of gallstones:

• cholesterol gallstones, which are most common and made up of excess cholesterol
• pigment gallstones, which are made up of excess bilirubin

Surgery is a common treatment for gallstones, but you may be able to treat them with natural remedies. Read on to learn natural remedies for gallstones, plus tips to help prevent this condition.

Gallstones can cause sharp, intense pain in the upper right part of the abdomen. This pain may radiate to your back and up to your shoulder blade. Other symptoms include nausea, vomiting, light-colored or gray stool, and diarrhea.

Talk with your doctor before trying to treat gallstones on your own. Your doctor can help you receive the correct diagnosis. They can also advise you on all of your treatment options. If you have yellowing of the eyes, fever or chills, and intense abdominal pain, seek medical care immediately.

1. Gallbladder cleanse

There are several reasons why gallstones may form:

• Your liver may secrete more bile than it can dissolve.
• Your body may have excess pigment called bilirubin, which cannot be dissolved.
• The gallbladder might not empty completely or as frequently as it needs to.

Some people claim that a gallbladder cleanse or flush can help break up the gallstones and empty the gallbladder. There is no scientific evidence to support these claims, however. The body is able to cleanse and flush itself.

Still, some people consume a combination of olive oil, juice, and herbs for two or more days. During that time, they’re not supposed to consume anything other than the oil mixture. There’s no standard mixture or recipe. This mixture can be dangerous for people with diabetes, or those who experience low blood sugar.

One study looked at the role of olive oil and sunflower oil on gallstones. The researchers found that while olive oil had an effect on bile consumption, it did not affect the gallstones.

Talk to your doctor before beginning any type of cleanse. It may not be safe for all people.

2. Apple juice

Some people use apple juice to treat gallstones. That’s because they believe apple juice may soften gallstones and can help you pass the stones.This claim has spread due to a letter published in 1999, which detailed an anecdotal account of a woman successfully passing her gallstones with the use of apple juice. There are no scientific studies that support this claim, however.

Drinking lots of fruit juice may not be healthy for you if you have diabetes, hypoglycemia, stomach ulcers, and other conditions.

3. Apple cider vinegar

Apple cider vinegar (ACV) is a popular health supplement that’s often included in cleanses. While ACV may have positive effects on blood sugar, there are no studies to support the use of ACV for the treatment of gallstones. There is little evidence that cleanses are needed or effective.

4. Yoga

There are some claims that yoga may help you naturally pass gallstones. Yoga was found in one study to improve lipid profile in people with diabetes. In another study, researchers looked at people with cholesterol gallstones and found that people with these types of gallstones were more likely to have abnormal lipid profiles. The researchers were unable to find a connection between these abnormal levels and the presence of gallstones, however.

While yoga may help relieve some of the symptoms associated with gallstones, there is no scientific evidence to support the use of yoga for the treatment of gallstones.

5. Milk thistle

Milk thistle, or Silybum marianum, may help treat liver and gallbladder disorders. It’s thought to stimulate both organs, but researchers have not specifically looked at the benefits of milk thistle for the treatment of gallstones.

Milk thistle is available in pill form as a supplement. Talk to your doctor before using milk thistle, especially if you have diabetes. Milk thistle may lower blood sugar levels in people with type 2 diabetes. It’s also possible to be allergic to milk thistle.

Shop for milk thistle

6. Artichoke

Artichoke has been found to be beneficial for gallbladder function. It helps stimulate bile and is also beneficial for the liver. No studies have looked at the effect of artichoke on the treatment of gallstones.

Artichoke can be steamed, pickled, or grilled. There is no harm in eating artichoke if you’re able to tolerate it. Artichoke in pill form or sold as a supplement should only be taken after you speak to your doctor.

7. Gold coin grass

Gold coin grass, or Lysimachiae herba, is used in traditional Chinese medicine to treat gallstones. It’s been linked to reduced gallstone formation. Some people recommend taking gold coin grass before beginning a gallstone cleanse to help soften the stones.

You can purchase gold coin grass in powder or liquid form.

8. Castor oil pack

Castor oil packs are another folk remedy, and some people choose to use this method instead of a gallbladder cleanse. Warm cloths are oaked in castor oil, which you then place on your abdomen. The packs are supposed to relieve pain and help treat your gallstones. There are no scientific studies to support claims that this treatment is effective.

Shop for castor oil

9. Acupuncture

Acupuncture may help relieve some of the pain from gallstones by reducing spasms, easing bile flow, and restoring proper function. Acupuncture has been reported to treat gallstones, but more research is needed.

One small study was done to look at the effects of acupuncture on cholecystitis in 60 participants. Cholecystitis is inflammation of the gallbladder. Acupuncture was found to relieve symptoms and reduce the volume of the gallbladder.

More research is needed to specifically look at the benefits of acupuncture for the treatment of gallstones.

Acupuncture is relatively safe. When choosing an acupuncturist, look for a licensed acupuncturist and make sure that they are using new, single-use needles. In some cases, your insurance provider may cover part of the cost. Many cities also have community acupuncture centers. Acupuncture is administered in a room with other people instead of in a private setting. The cost for community acupuncture is often a lot more affordable than private acupuncture.

Medications and surgery are often used to treat gallstones.

Medication

Two bile acids are often prescribed to dissolve smaller gallstones:

• ursodeoxycholic acid
• chenodeoxycholic acid

In an older study from 1989, ursodeoxycholic acid helped prevent gallstone formation in obese people who were following very low-calorie diets.

It may take up to two years for bile acids to treat gallstones. Gallstones may re-form when you stop taking the medication.

Surgery

Surgery is often the recommended treatment for gallstones. Surgery, known as cholecystectomy, involves removing the gallbladder, so gallstones are not able to form again following this treatment.

A gallbladder is not needed for survival, and in most people, the body is able to compensate for the loss of the gallbladder with minimal side effects. Learn more about gallbladder removal surgery.

Gallstones are most common in:

• women
• people 40 years and older
• people with diabetes
• people who are obese
• pregnant women
• people who take hormonal medications
• people who eat high-fat diets

A combination of genetics, diet, and lifestyle factors are likely the cause of gallstones formation.

Diet

A 2006 study reported that women who ate more fruits and vegetables had a lower risk for gallbladder removal surgery than women who ate the least fruits and vegetables. A well-balanced diet that includes a variety of fruits and vegetables may help support a healthy gallbladder and reduce your risk for gallstones. It may also help with weight management.

Some foods may aggravate the gallbladder, including:

• eggs
• refined sugar
• foods with lots of saturated fat
• food allergens

Talk to your doctor about specific foods you may want to avoid.

Weight management

Obesity increases your risk for developing gallstones. Losing weight can be an important part of preventing gallstones, but the way you lose weight matters. Following a very low-calorie diet for weight loss may actually increase your risk for gallstones.

In a 2013 study, participants followed a one-year commercial weight loss program. During the program, one group of participants followed a very low-calorie diet (500 kcal/day) for 6-10 weeks. The other group followed a low-calorie diet (1200-1500 kcal/day) for three months. The group that followed the very low-calorie diet was three times more likely than the other group to develop gallstones that required hospitalization or surgery.

Talk to your doctor about a healthy weight loss program if you are trying to lose weight. They can help you develop a healthy weight loss plan.

There’s little research on the efficacy of natural treatments for gallstones.

Any herbs or supplements sold in the United States are not monitored for quality or purity by the Food and Drug Administration. Research any products carefully, talk to your doctor, and choose from a reputable company. If your doctor has recommended surgery, have an open conversation with them about other options you may be able to try first.

City Clinical Hospital No. 31 im. Academician G.M. Savelyeva

Many women carry gallstones. Is it always necessary to remove the gallbladder in this case? Is there an alternative to surgery?

Head of the Department of Hospital Surgery of the Russian State Medical University, surgeon of the 31st City Clinical Hospital of Moscow, doctor of medical sciences, professor Sergey Georgievich Shapovalyants .

– Is it necessary to remove the gallbladder if only one small stone has formed in it? Is it worth sacrificing an entire organ?

– Many patients ask this question, because few people want to take drastic measures right away. They believe that small gallstones pose no danger and can simply be observed. And sometimes this tactic is actually used. However, it must be recognized that it is very, very dangerous. After all, even small stones can cause serious complications. If large formations can lead to bedsores, breakthroughs of the gallbladder, then small stones are insidious in their own way. They can migrate and enter the bile ducts. Wandering through them, the stones reach the level of confluence with the duodenum 12 and get stuck there. Due to a violation of the outflow of bile, the pigment bilirubin begins to accumulate in the blood, and obstructive jaundice occurs. In addition, a severe attack of acute pancreatitis can quickly develop. In this case, there is no time for reflection – an ambulance of a doctor is needed.

All patients should also know that once a stone has formed in the gallbladder, it will never completely dissolve. The presence of even the smallest stones indicates that the work of the gallbladder is impaired, bile begins to precipitate. And if this trend has appeared, it will develop.

– But there is a method of dissolving stones with the help of medicines. Why not try it before going to the surgeon?

– Indeed, there are drugs that can try to influence some gallstones. But not completely dissolve them – this does not happen, but only slightly reduce their size. This can be done only with a strict combination of the size of the stone, its chemical composition, the contractile function of the gallbladder and the tolerance of drugs.

Bile acids are used to dissolve stones. Two of them are used as drugs – chenodeoxycholic acid and ursodeoxycholic acid. These drugs are produced by many companies under different names. Some of the most famous are Henofalk and Ursofalk. With the help of these funds, it is possible to act exclusively on cholesterol stones. If there is a lot of calcium or bilirubin in the stones, then the use of bile acids is useless. They never dissolve these substances.

Gallstones should not exceed 2 cm in diameter. Larger formations can of course be reduced. However, this will take a very long time, up to several years, because on average stones decrease by 1 mm per month.

In addition, stones can be dissolved only if the function of the gallbladder is preserved, when it continues to contract normally and excrete bile. And with acute inflammatory diseases of the gallbladder and bile ducts, with liver diseases, peptic ulcers of the stomach and intestines, this is contraindicated and pointless.

It is also worth mentioning that the intake of bile acids is very often accompanied by undesirable reactions, in particular, stool disorder. But despite this, the patient must regularly and for a long time, at least several months, take these drugs. One has only to stop treatment – and the stones grow again. So the drug method has a very limited effectiveness.

-What about the method of crushing gallstones? Do they crush kidney stones?

– Analogies between the crushing of kidney and gallstones are actually often made. At one time, gallstones were crushed by extracorporeal lithotripsy. Moreover, this method was very popular. During the lithotripsy session, multiple shock waves were directed at the stone outside the body. As a result of this impact, the stone was crushed into fragments. Then small fragments independently left the body through the bile ducts and intestines. At the same time, large fragments that could not pass through the duct remained in the gallbladder.
But this is not so bad. The fragments formed as a result of crushing often got stuck in the bile ducts, clogged them and disrupted the entire process of bile secretion.

There is another important point. Before lithotripsy, stones are usually even, smooth, adapted to the shape of the gallbladder. And a person often does not feel them. As soon as you crush it, turn it into a mass of small but sharp fragments, biliary colic, jaundice appear, and the pancreas becomes inflamed. The patient’s condition may worsen. So this method can be considered simply dangerous, and many foreign and domestic clinics refuse it.

– Clearly, all conservative methods do not bring great success. But if you decide on an operation, why is it necessary to remove the whole organ? Is it possible to remove only the stones, and leave the gallbladder?

– Alas, this method is recognized as ineffective today, although it is still practiced in some places. There is an opinion that some patients, especially young ones, should not have their gallbladder removed. Still, it performs certain important functions in the body.

Proponents of this approach perform an operation during which a small incision is made in the gallbladder. Gallstones are taken out through it, then the bladder is sewn up, and after two or three days the satisfied patient returns home. No stones, and the gallbladder is in place.

However, not everything is so simple. Approximately 2-3 months after such an operation, cholelithiasis raises its head again. The same symptoms and complications return that the person had before the intervention. The percentage of recurrence at different intervals reaches almost 100%. This is due to the fact that one of the prerequisites for the formation of stones in the gallbladder is its poor contractility. Such a bubble is called stagnant. Another reason is the congenital features of the structure of bile. When bile in any diet, even purely vegetarian, is concentrated and precipitated. In this case, the removal of stones alone is simply meaningless. The problem can be finally solved only by the complete elimination of the gallbladder.

– Does this always require an abdominal operation?

– Of course not. In large clinics and hospitals, gallbladder removal is performed by laparoscopy. The operation is performed through three or four punctures in the abdominal wall. An optical system is introduced inside. The abdominal cavity is examined and the gallbladder is removed with special tools.

As a rule, this is where the patient’s troubles end. After a short period of adaptation, he can forever forget about gallstone disease. Moreover, the absence of the gallbladder will remain almost invisible to him. Indeed, in fact, his “biological loss” occurred much earlier – even at the stage of stone formation. Even then, the gallbladder ceased to function normally, and other parts of the biliary system took over the performance of its work.

– To be honest, I know of cases when after such an operation people did not feel better, but even worse… What do you say about that?

– You are right, there is such a thing as postcholecystectomy syndrome. It implies just the deterioration of well-being that you are talking about. Most often this happens if the operation is done at an already advanced stage of the disease. When neighboring organs are involved in the inflammatory process. In this situation, only one thing can be said – do not take it to extremes. Do the operation as planned, and not when the “thunder strikes.”

But there is another reason for the bad state. And this is a rather serious problem with deep roots. The fact is that the operation of removing the gallbladder began to be considered technically simple for doctors and quite easily tolerated by patients. For these reasons, many people go for it without much thought. Although in reality it is not always necessary to do this.

The range of examinations passed by the patient is often limited to one ultrasound of the abdominal cavity. Moreover, according to its results, a person may not have stones as such, but “clots” or “suspensions” are found. True, the patient makes some complaints similar to the symptoms of gallstone disease. They are the basis for the decision.

The patient is quickly operated on, and the operation does not bring relief. The question arises: was the gallbladder really the cause of poor health? After all, the same symptoms can occur due to other problems, in particular, due to duodenal dyskinesia. And if in such a situation the gallbladder is removed – a kind of buffer that alleviates unpleasant manifestations – then the existing problems will immediately worsen. A pain syndrome will appear, the whole complex of symptoms will emerge.

– What to do in such a situation?

– How sad it is to open a new medical history. In general, in order to avoid such a development of events, before the operation, it is necessary to undergo a thorough examination not only of the gallbladder, but also of all nearby organs. It is necessary to carefully assess the condition of the bile ducts, pancreas, duodenum, right kidney, stomach. Not all medical institutions are equipped for this with the necessary equipment. Therefore, it is better to contact large clinics and centers.

Endoscopic bile duct ultrasonography is currently used successfully in cases of suspected gallstones. After all, if there are also stones there, then first you need to eliminate them, and only then take on the gallbladder. To avoid those complications.

Computed tomography can help examine the liver and pancreas. Many of the necessary details will tell a biochemical blood test. Of course, not everyone needs these studies. But if there are any doubts, they cannot be ignored.

So take care of yourself. Go to drastic measures deliberately, and trusting your doctor.

Be aware! Prerequisites for the occurrence of gallstone disease are:

1. Overweight;

2. Sedentary lifestyle;

3. Pregnancy.

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Is it possible to dissolve gallstones and how to do it correctly?

There is now a significant increase in interest in the dissolution of gallstones. According to scientific studies, the indications for the treatment of gallstone disease without surgery using the dissolution of stones are rather limited, and there are also a large number of contraindications. To find out the medical view of what are the possibilities for dissolving gallstones, we recommend that you read this article.

General information

Gallstone disease (GSD) – a disease accompanied by the formation of stones (calculi) in the gallbladder and biliary tract, with a hereditary predisposition, according to statistics, occurs in 10-15% of the population. It can proceed both asymptomatically and with an abundance of various complaints and complications. In recent years, the number of cases of gallstone disease among younger people has increased, however, this disease is more common in women.

The possibility of dissolution of gallstones is influenced by many factors – their variety and composition, size, location, as well as the absence or presence of exacerbations of cholelithiasis and other factors. Let’s look at everything in order.

Types of stones in the gallbladder and bile ducts

Depending on the composition and method of formation, there are two main types of gallbladder stones – cholesterol and pigment.

Cholesterol stones

Cholesterol stones form predominantly in the gallbladder and consist mainly of cholesterol, the proportion of which usually exceeds 60%. In addition to cholesterol, they may contain protein compounds (mucins), bilirubin compounds with calcium and calcium salts, as well as small amounts of other substances. “Pure” 100% cholesterol stones make up approximately 10-15% of all cholesterol stones. Stones containing less than 60% cholesterol are called mixed.

One of the main reasons for the formation of cholesterol stones is an increased saturation of bile with cholesterol, in addition, the formation of such stones can contribute to a delay in the emptying of the gallbladder.

Pigment stones

Pigment stones account for 10-25% of all gallstones in patients in European countries, but among the population of Asian countries, their incidence is much higher. Like cholesterol, pigment stones are more common in women. They are usually small, fragile, black or dark brown in color and are formed mainly on the basis of bilirubin compounds.

Black pigment stones consist of a black polymer formed from bilirubin and calcium, as well as other compounds of calcium, copper and a large number of complex proteins (mucins). These stones do not contain cholesterol and do not have a distinct crystal structure.

Black pigment stones are more common in patients with liver cirrhosis, in chronic hemolytic conditions (hereditary spherocytic or sickle cell anemia in patients with vascular prostheses, artificial heart valves, etc.). Their formation is facilitated by a supersaturation of bile with indirect, water-insoluble bilirubin and a change in the acidity of bile (pH).

Brown pigment stones consist mainly of calcium salts of indirect bilirubin with the inclusion of varying amounts of cholesterol and proteins.

The formation of brown pigment stones is associated with the presence of infection (cholecystitis, ascending cholangitis), and microscopic examination reveals the structural elements of bacteria in them. Such stones are formed already in the bile ducts under the action of enzymes produced by bacteria.

Pigment stones can form both in the gallbladder and in the ducts, and in the ducts they are detected more often than stones of other composition. In recent decades, there has been a decrease in the frequency of detection of pigment stones, which many researchers attribute to a decrease in the incidence of infectious and inflammatory diseases of the biliary tract.

Which gallstones can be dissolved and with what?

Now let’s look at the situations in which drug dissolution of stones is possible. To dissolve stones, preparations of ursodeoxycholic and chenodosoxyzolic acids are used. Preference is given to the former due to its higher efficiency and lower frequency of side effects.

Can be dissolved :

1. Radiolucent (not visible on radiographs) cholesterol stones with preserved contractile activity of the gallbladder.
2. Radiopositive (lighter on radiographs) stones less than 88 HU on CT scan.
3. Solitary cholesterol stones, no larger than 10 mm.
4. Multiple small cholesterol stones, 5 mm or less, not exceeding 50% of the total gallbladder volume.

What will help you succeed?

Remember that the decision on the possibility of dissolution of stones in the cavity of the gallbladder is made only by a specialist. A gastroenterologist and surgeon can help make an informed decision to assess the possibility of such medical treatment and evaluate all the associated risks.

All attempts at dissolution, which are made without a doctor’s recommendation, may result in the removal of the gallbladder on an emergency basis – along with this, the risks of complications during and after the operation increase.

It is also important to know that the scope of the operation during an emergency operation often expands and may no longer require video laparoscopic intervention from a mini-access, but traditional removal of the gallbladder using large incisions of the anterior abdominal wall, which is accompanied by its significant trauma and more frequent postoperative complications – hernias, infections, etc.

Instrumental studies for the diagnosis of cholelithiasis

When a doctor decides to prescribe drugs to dissolve stones, it is of great importance to analyze the patient’s complaints, medical history data and the results of examination and instrumental studies.

The leading position in the diagnosis of cholelithiasis is rightfully occupied by ultrasound using modern ultrasonic devices . The sensitivity and specificity of high-resolution ultrasonography for the detection of gallstones exceed 95%. It is possible to identify stones up to 2 mm in diameter.

In time, ultrasound determines the size of the gallbladder, the degree of thickening of its wall, reveals kinks and constrictions of the bladder, intracavitary structures – stones, polyps, gallstones, etc. It is possible to conduct stress tests to study the functional activity (contractility) of the gallbladder.

Using ultrasound, it is possible to determine the expansion of intra- and extrahepatic ducts, the presence of stones in them (in 50-60% of cases). If an ultrasound scan reveals an expansion of the common bile duct (more than 6-7 mm), the probability of the presence of stones in the common bile duct reaches 75%. It is also important to assess the condition of the pancreas and liver.

It should be noted that the information content of ultrasound is significantly reduced in the presence of a large amount of gas in the intestine and severe obesity.

In order to clarify the density characteristics of stones , to assess the signs of their calcification, if necessary, it is possible to conduct an X-ray survey, computed and magnetic resonance imaging of the abdominal organs.

Other research methods – endoultrasound, magnetic resonance cholangiography are performed strictly according to the indications and doctor’s prescription.

When should gallstones not be dissolved?

1. In case of previous biliary colic.

   How does biliary colic manifest itself?

   These are sudden onset and usually recurring attacks of intense pain. Such attacks can be provoked by the use of sweets, smoked, fried foods or alcohol, physical activity, taking certain medications (antibiotics, NSAIDs).

   Colic is characterized by the following pattern:

   • The attack occurs suddenly, can last for hours, less often – more than 24 hours.
   • Pain is acute, intense, paroxysmal, as a rule, localized in the right hypochondrium, epigastric region, projection of the lower third of the sternum.
   • Pain may radiate to the back, jaw, neck or interscapular space.
   • An attack may be accompanied by:
   • nausea,
   • vomiting without relief
   • infrequently – an increase in body temperature.

   It is important to remember that an attack of pain lasting more than 6 hours may indicate the development of acute cholecystitis and requires a doctor’s consultation to resolve the issue of emergency hospitalization .

2. In the presence of radio-positive (calcified, “dark” on radiographs) stones, with a density of more than 88 HU according to computed tomography.
3. When a non-functioning gallbladder (“disabled”) is detected N.B.! Extremely high risks of complications with the development of obstructive jaundice, peritonitis.
4. When stones occupy more than 30% of the gallbladder cavity.
5. With a long history of the disease. N.B.! Stones that appeared many years ago often contain a large amount of calcium salts, and drugs with a dissolving effect can cause acute surgical complications.
6. Calcified stones.
7. Previous episode of acute cholecystitis treated with medication. N.B! Described gallbladder requires elective removal.
8. Infectious and inflammatory diseases of the biliary tract.
9. “Injected” stone in the neck of the gallbladder.
10. Fixed, immobile stones – especially in the neck of the gallbladder N.B! High risks of bedsores or pathological anastomosis between the gallbladder and internal organs or the anterior abdominal wall.

Why is it dangerous to use traditional medicine?

The use of traditional medicine to dissolve stones is not recommended, primarily because there is no evidence base for their effectiveness, there are no recommendations on their safety, and possible side effects and contraindications are not described.

In addition, there are cases of complications after the use of traditional medicine, when patients had to be urgently hospitalized in a hospital.