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Effects of Ursodeoxycholic Acid and Aspirin on the Formation of Lithogenic Bile and Gallstones during Loss of Weight

Broomfield, Paul H., Chopra, Rakesh, Sheinbaum, Richard C., Bonorris, George G., Silverman, Alan, Schoenfield, Leslie J., Marks, Jay W.·1988·New England Journal of Medicine
DOI 10.1056/nejm198812153192403
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Abstract

We attempted to determine whether the administration of aspirin or ursodeoxycholic acid during loss of weight could prevent the development of lithogenic changes in bile and the formation of gallstones. Sixty-eight obese subjects without gallstones who were entered in a program (520 kcal per day) to lose weight were randomly assigned to receive ursodeoxycholic acid (1200 mg per day), aspirin (1300 mg per day), or placebo in double-blind fashion for up to 16 weeks. At entry, at four weeks of treatment, and at three weeks after the completion of treatment, the subjects underwent ultrasonography to detect gallstones and duodenal drainage of bile to detect cholesterol crystals and to determine the bile saturation index and glycoprotein concentration. No gallstones or cholesterol crystals formed in the patients treated with ursodeoxycholic acid. Among the patients given placebo, gallstones formed in five (P less than 0.05 vs. ursodeoxycholic acid) and cholesterol crystals in six (P less than 0.001 vs. ursodeoxycholic acid); among those given aspirin, gallstones formed in two and cholesterol crystals in one (no significant difference from ursodeoxycholic acid treatment). By the fourth week, the bile saturation index increased in the placebo group (from 1.07 +/- 0.26 to 1.29 +/- 0.27; P less than 0.001), decreased in the ursodeoxycholic acid group (from 1.11 +/- 0.34 to 0.91 +/- 0.24; P less than 0.001), and did not change significantly in the aspirin group. The concentration of gly…

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  • Previous studies of VLCD-induced rapid weight loss have generally been small, of short duration, lacked control groups and used formulations with lower amounts of fat compared with formulations used today.

    “Previous studies of VLCD-induced rapid weight loss have generally been small, of short duration, lacked control groups and used formulations with lower amounts of fat compared with the formulations used today.10, 11, 12, 13, 14”

    From Risk of symptomatic gallstones and cholecystectomy after a very-low-calorie diet or low-calorie diet in a commercial weight loss program: 1-year matched cohort study (2014) · cites this paper as [10]

  • Extremely rapid (>1.5 kg/week) or excessive weight reduction (>25% of total body weight) may lead to a lithogenic state and initiate biliary sludge and gallstones.

    “However, the following two specific settings are exceptions: extremely rapid (>1.5 kg/week) or excessive weight reduction (>25% of the total body weight) [202122]. Both cases may occur after bariatric surgery or administration of weight loss medications, which may lead to a lithogenic state and subsequently initiate biliary sludge and gallstones [22].”

    From Prevention of Gallstones After Bariatric Surgery using Ursodeoxycholic Acid: A Narrative Review of Literatures (2022) · cites this paper as [20]

  • The prophylactic use of UDCA during the weight reduction phase, regardless of the method of weight loss, has been proven to reduce gallstone formation, with reduction rates up to 58% in a few clinical trials.

    “The prophylactic use of UDCA during the weight reduction phase, regardless of the method of weight loss (low-calorie diet, bariatric surgery, etc.), has been proven to reduce gallstone formation, with reduction rates of up to 58% in a few clinical trials [2025444546474849].”

    From Prevention of Gallstones After Bariatric Surgery using Ursodeoxycholic Acid: A Narrative Review of Literatures (2022) · cites this paper as [20]

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Metadata

Authors
Broomfield, P. H., Chopra, R., Sheinbaum, R. C., Bonorris, G. G., Silverman, A., Schoenfield, L. J., & Marks, J. W.
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
1988-12-15
Volume
319
Issue
24
Pages
1567-1572
ISSN
  • 0028-4793
  • 1533-4406
DOI
10.1056/nejm198812153192403
Cited by
222
References
0
Language
en

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