Ursodeoxycholic acid in the management of symptomatic gallstone disease: systematic review and clinician survey.

Lewis Hall, James Halle-Smith, Richard Evans, Giles Toogood, Tom Wiggins, Sheraz R Markar, Spyros Kapoulas, Paul Super, Olga Tucker, Siobhan C McKay

BJS open 2023 Mar 07

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Symptomatic gallstones are common. Ursodeoxycholic acid (UDCA) is a bile acid that dissolves gallstones. There is increasing interest in UDCA for symptomatic gallstones, particularly in those unfit for surgery. A UK clinician survey of use and opinions about UDCA in symptomatic gallstones was performed, assessing clinicians' beliefs and perceptions of UDCA effectiveness. A systematic review was performed in accordance with the PRISMA guidelines. PubMed, MEDLINE, and Embase databases were searched for studies of UDCA for symptomatic gallstones (key terms included 'ursodeoxycholic acid'; 'UDCA'; 'biliary pain'; and 'biliary colic'). Information was assessed by two authors, including bias assessment, with independent review of conflicts. Overall, 102 clinicians completed the survey, and 42 per cent had previous experience of using UDCA. Survey responses demonstrated clinical equipoise surrounding the benefit of UDCA for the management of symptomatic gallstones, with no clear consensus for benefit or non-benefit; however, 95 per cent would start using UDCA if there was a randomized clinical trial (RCT) demonstrating a benefit. Eight studies were included in the review: four RCTs, three prospective studies, and one retrospective study. Seven of eight studies were favourable of UDCA for biliary pain. Outcomes and follow-up times were heterogenous, as well as comparator type, with only four of eight studies comparing with placebo. Evidence for UDCA in symptomatic gallstones is scarce and heterogenous. Clinicians currently managing symptomatic gallstone disease are largely unaware of the benefit of UDCA, and there is clinical equipoise surrounding the benefit of UDCA. Level 1 evidence is required by clinicians to support UDCA use in the future. © The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.

Citation

Lewis Hall, James Halle-Smith, Richard Evans, Giles Toogood, Tom Wiggins, Sheraz R Markar, Spyros Kapoulas, Paul Super, Olga Tucker, Siobhan C McKay. Ursodeoxycholic acid in the management of symptomatic gallstone disease: systematic review and clinician survey. BJS open. 2023 Mar 07;7(2)