Chenotherapy for gallstone dissolution. II. Induced changes in bile composition and gallstone response
A. F. Hofmann, J. L. Thistle, P. D. Klein, P. A. Szczepanik and P. Y. Yu
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.
