CoChat
Sign Up
Cited by 34

The DOI matches its Crossref record.

Gall stone recurrence and its prevention: the British/Belgian Gall Stone Study Group's post-dissolution trial.

Hood, K A, Gleeson, D, Ruppin, D C, Dowling, R H·1993·Gut
DOI 10.1136/gut.34.9.1277
Open this paper in CoChat — free account

Abstract

The British/Belgian Gall Stone Study Group (BBGSG) post-dissolution trial was a prospective, multicentre, randomised, double blind trial of: (i) low dose ursodeoxycholic acid, (ii) placebo, and (iii) a high fibre, low refined carbohydrate diet in the prevention of gall stone recurrence in patients with complete gall stone dissolution. Further aims included establishing the timing and frequency of recurrence and its association with biliary symptoms, a comparison of the sensitivity of ultrasonography v oral cholecystectography in detecting recurrent stones, and a search for risk factors predicting recurrence. Ninety three patients entered the study, and 82 were followed up for up to five years (mean (SEM) 28 (1.5) months) with six monthly ultrasonography and yearly oral cholecystectography. There were 21 recurrences (26 by oral cholecystectography or ultrasonography, or both), only two of which were symptomatic, which were detected between 12 and 42 months after trial entry. This corresponded to an actuarial recurrence rate of 33.9 (7.0%) by lifetable analysis at 42 months and subsequently. There were four recurrences in the ursodeoxycholic acid, six in the placebo, and 11 in the diet groups, corresponding to 21.9 (9.9)%, 27.4 (10.1)%, and 45.8 (12.4)% respectively at 42 months by lifetable analysis (NS). Variables including age, obesity, menopausal state, pregnancy, and oestrogen containing drugs were not shown to affect recurrence rate. Men had more frequent recurrence than women (NS). Patients who had had multiple stones experienced more recurrences than did those with single stones (NS). Recurrence did not occur in patients who took non-steroidal anti-inflammatory drugs (NSAIDs) (p < 0.02). The stone free interval between stone dissolution and trial entry proved to be important--those stone free > nine months had a recurrence rate of only 12.7 (6.0)% at 42 months compared with 55.4 (12.5)% in those stone free < nine months (p < 0.01). There was imbalance between the ursodeoxycholic acid and placebo groups for this factor, and after applying a statistical correction, the adjusted recurrence rate in the ursodeoxycholic acid group was 15% compared with 30% in both placebo and diet groups (NS). These data suggest that after medical dissolution, the risk of gall stone recurrence is not reduced by a high fibre, low refined carbohydrate diet: it may be lowered, but not abolished, by low dose ursodeoxycholic acid.

Overview

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1136/gut.34.9.1277

Cites

Statistics

Verification

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Ursodeoxycholic acid administered during very low-calorie dieting and weight loss after bariatric surgery is effective in preventing gallstone formation.

    “Ursodeoxycholic acid administered during VLCD and weight loss after bariatric surgery is effective in preventing gallstone formation19–23”

    From Gallstone Formation Prophylaxis After Gastric Restrictive Procedures for Weight Loss: A Randomized Double-Blind Placebo-Controlled Trial (2003) · cites this paper as [20]

    The post-dissolution trial studied gallstone recurrence, not new gallstone formation during very low-calorie dieting or after bariatric surgery. Its discussion of post-dissolution treatment says ursodeoxycholic acid may reduce or delay recurrence, but the reduction was not statistically significant and the authors say it did not prevent recurrence. The paper therefore offers limited support for a protective effect, not for the claimed effectiveness in the specified weight-loss settings. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • In prospective randomized studies, prophylactic administration of ursodeoxycholic acid has been shown to be effective in gastric bypass procedures, as well as in a small series with vertical banded gastroplasty.

    “In prospective randomized studies, the prophylactic administration of ursodeoxycholic acid has been shown to be effective in gastric bypass procedures20–22, as well as in a small series with vertical banded gastroplasty.23”

    From Gallstone Formation Prophylaxis After Gastric Restrictive Procedures for Weight Loss: A Randomized Double-Blind Placebo-Controlled Trial (2003) · cites this paper as [20]

    The Abstract describes a randomized trial of ursodeoxycholic acid to prevent gallstone recurrence after complete stone dissolution, not after bariatric surgery. Searches for vertical banded gastroplasty and gastric bypass found no passage addressing either procedure, so our copy cannot verify the claim attached to citation 23. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Citations

Cites

No references could be resolved yet.

Research works printed but not linked: 57

  1. Iser JH, Murphy GM, Dowling RH. Speed of change in biliary lipids and bile acids with chenodeoxycholic acid - is intermittent therapy feasible? Gut 1977; 18: 7-15. · DOI
  2. Mok HYI, Bell GD, Dowling RH. Effect of different doses of chenodexycholic acid on bile-lipid composition and on frequency of side-effects in patients with gallstones. Lancet 1974; ii: 253-7.
  3. Thistle JL, Yu PYS, Hofmann AF, Ott BJ. Prompt return of bile to supersaturated state followed by gallstone recurrence after discontinuance of chenodeoxycholic acid therapy [Abstract]. Gastroenterology 1974; 66: 789.
  4. Ruppin DC, Dowling RH. Is recurrence inevitable after gallstone dissolution by bile acid treatment. Lancet 1982; i: 181-5. · DOI
  5. Thistle JL. Medical management of gallstones. Prac Gastroenterol 1981; 5: 351-6.
  6. Toulet J, Rousset J, Viteau JM, Douchon Y, Pagniez R, Samain B, et al. Recidives et prevention des recidives apres dissolution de la lithiase vesiculaire par l'acide chenodeoxycholic chez 22 patients. Gastroenterol Clin Biol 1983; 7: 605-9.
  7. Gleeson D, Ruppin DC, and the British Gallstone Study Group. Discrepancies between cholecystography and ultrasonography in the detection of recurrent gallstones. JHepatol 1985; 1: 597-607. · DOI
  8. Shaffer EA, Small DM. Biliary lipid secretion in cholesterol gallstone disease. The effect of cholecystectomy and obesity. J7 Clin Invest 1977; 59: 828-40.
  9. Reuben A, Maton PN, Murphy GM, Dowling RH. Bile lipid secretion in obese and non-obese individuals with and without gallstones. Clin Sci 1985; 69: 71-9. · DOI
  10. Boston Collaborative Drug Surveillance Program: oral contraceptives and venous thromboembolic disease, surgically confirmed gallbladder disease, and breast tumours. Lancet 1973; i: 1399-404.
  11. Boston Collaborative Drug Surveillance Program: surgically confirmed gallbladder disease, venous thromboembolism, and breast tumours in relation to postmenopausal estrogen therapy. NEnglJMed 1974; 290: 15-9. · DOI
  12. Jorgensen T. Gallstones in a Danish population; fertility period, pregnancies, and exogenous female sex hormones. Gut 1988; 29: 433-9. · DOI
  13. Hood KA, Gleeson D, Ruppin DC, Dowling RH, and the British/Belgian Gallstone Study Group. Prevention of gallstone recurrence by non-steroidal anti-inflammatory drugs. Lancet 1988; ii: 1223-5.
  14. Barbara L, Sama C, Labate AMM, et al. A population study on the prevalence of gallstone disease: the Sirmione study. Hepatology 1987; 7: 913-7. · DOI
  15. Scragg RKR, McMichael AJ, Baghurst PA. Diet, alcohol and relative weight in gallstone disease. BMJ7 1984; 288: 1113-9.
  16. Iser JH, Maton PN, Murphy GM, Dowling RH. Resistance to chenodeoxycholic acid (CDCA) treatment in obese patients with gall stones. BMJ 1978; 1: 1509-12. · DOI
  17. Reuben A, Maton PN, Murphy GM, Dowling RH. Bile lipid secretion in obese and non-obese individuals with and without gallstones. Clin Sci 1985; 69: 71-9. · DOI
  18. Schoenfield LJ, Lachin JM, The Steering Committee and the National Cooperative Gallstone Study Group. Chenodiol (chenodeoxycholic acid) for dissolution of gallstones: The National Cooperative Gallstone Study. Ann Intern Med 1981; 95: 257-82. · DOI
  19. Somerville KW, Rose DH, Bell GD, Ellis WR, Knapp DR. Gallstone dissolution and recurrence: are we being misled. BMJ 1982; 284: 1295-8. · DOI
  20. Shapero TF, Rosen IE, Wilson SR, Fisher MM. Discrepancy between ultrasound and oral cholecystography in the assessment of gallstone dissolution. Hepatology 1982; 2: 587-90. · DOI
  21. Admirand WH, Small DM. The physico-chemical basis of cholesterol gallstone formation in man. 7 Clin Invest 1968; 47: 1043-52.
  22. Maton PN, Murphy GM, Dowling RH. Lack of response to chenodeoxycholic acid in obese and non-obese patients: role of cholesterol synthesis and possible response to ursodeoxycholic acid. Gut 1980; 21: 1082-6.
  23. Gleeson D, Scrivens N, Murphy GM, Dowling RH. Resistance and acquired tolerance to ursodeoxycholic acid (UDCA): A possible cause of treatment failure. Clin Sci 1986; 70: A26.
  24. Maton PN, Murphy GM, Dowling RH. Ursodeoxycholic acid treatment of gallstones: Dose-response study and possible mechanism of action. Lancet 1977; ii: 1 297-301.
  25. Toor EW, Evans DF, Cussler EL. The nucleation of cholesterol monohydrate crystals in model bile solutions. In: Fisher MM, Goresky CA, Shaffer EA, Strasberg SM, eds. Gallstones. New York: Plenum Press, 1972: 169-82.
  26. Northfield TC, Jazrawi RP, Petroni ML. Medical dissolution therapy. In: Paumgartner G, Barbara L, Stiehl A, Roda E, eds. Strategies for the treatment of hepatobiliary diseases. Dordrecht: Kluwer Academic Publishers, 1990: 163-80.
  27. Pomare EW, Heaton KW, Low-Beer TS, Espiner HJ. The effect of wheat bran upon bile salt metabolism and upon the lipid composition of bile in gallstone patients. Am J Dig Dis 1976; 21: 521-6. · DOI
  28. Heaton KW. The effect of dietary fibre on biliary lipids. In: Barbara L, Bianchi Porro G, Cheli R, Lipkin M, eds. Nutrition in gastrointestinal disease. New York: Raven Press, 1987: 213-22.
  29. Thornton JR, Emmett PM, Heaton KW. Diet and gallstones: effects of refined and unrefined carbohydrate diets on bile cholesterol saturation and bile acid metabolism. Gut 1983; 24:2-6.
  30. Peto R, Pike MC, Armitage P, Breslow NF, Cox DR, Howard SV, et al. Design and analysis of randomised clinical trials involving prolonged observation of each patient. II Analysis and examples. BrJ Cancer 1977; 35: 1-39.
  31. Fleiss JL. Statistical methods for rates and proportions. The standardisation rate. New York: John Wiley, 1981.
  32. Dowling RH, Gleeson D, Ruppin DC, Murphy GM, and the British/Belgian Gallstone Study Group. Gallstone recurrence and post-dissolution management. In: Paumgartner G, Stiehl A, Gerok W, eds. Enterohepatic circulation of bile acids and sterol metabolism. Lancaster: MTP Press, 1985: 361-9.
  33. Carey MC. Formation of cholesterol gallstones: the new paradigms. In: Paumgartner G, Stiehl A, Gerok W, eds. Trends in bile acid research. Dordrecht: Kluwer Academic, 1989: 259-81.
  34. Festi D, Frabboni R, Bazzoli F, Sangermano A, Ronchi M, Rossi L, et al. Gallbladder motility in cholesterol gallstone disease: effect of ursodeoxycholic acid administration and gallstone dissolution. Gastroenterology 1990; 99: 1779-85. · DOI
  35. Sylwestrowicz TA, Shaffer EL. Gallbladder function during gallstone dissolution. Gastroenterology 1988; 95: 740-8. · DOI
  36. Spengler U, Sackmann M, Sauerbruch T, Holl J, Paumgartner G. Gallbladder motility before and after extracorporeal shock-wave lithotripsy. Gastroenterology 1989; 96: 860-3. · DOI
  37. van Erpecum KJ, van Berge Henegouwen GP, Stoelwinder B, Schmidt YMG, Willekens FLH. Bile concentration is a key factor for nucleation of cholesterol crystals and cholesterol saturation index in gallbladder bile of gallstone patients. Hepatology 1990; 11: 1-6. · DOI
  38. Swobodnik W, Janowitz P, Kratzer W, Hagert N, Wenk H, Schumacher KA, et al. Diagnostic fine needle puncture of the gallbladder (DPG) under ultrasound guidance. Radiology 1991; 178: 755-8. · DOI
  39. Hussaini SH, Pereira SP, Kennedy C, Dowling RH. Is ultrasound-guided percutaneous transhepatic fine needle (22FG) puncture of the gallbladder (PFNP-GB) safe? Gastroenterology 1993; 104: A365.
  40. Villanova N, Bazzoli F, Taroni F, Frabboni R, Mazzella G, Festi D, et al. Gallstone recurrence after successful oral bile acid treatment. Gastroenterology 1989; 97: 726-31. · DOI
  41. Rhodes M, Allen A, Dowling RH, Murphy GM, Lennard TWJ. Inhibition of human gallbladder mucus synthesis in patients undergoing cholecystectomy. Gut 1992; 33: 1113-7. · DOI
  42. Lee SP, Carey MC, LaMont TJ. Aspirin prevention of cholesterol gallstone formation in prairie dogs. Science 1981; 211: 1429-30. · DOI
  43. LaMont TJ, Turner BS, DiBenedetto D, Handin R, Schafrer AI. Arachidonic acid stimulates mucin secretion in prairie dog gallbladder. AmJ Physiol 1983; 245: G92-8.
  44. Broomfield PH, Chopra R, Sheinbaum RC, et al. Effects of ursodoexycholic acid and aspirin on the formation of lithogenic bile and gallstones during loss of weight. N Engl JMed 1988; 319: 1567-72. · DOI · Paper page
  45. Ruppin DC, Murphy GM, Dowling RH, and the British Gallstone Study Group. Gall stone disease without gall stones - bile acid and bile lipid metabolism after complete gall stone dissolution. Gut 1986; 27: 559-66. · DOI
  46. Meredith TJ, Williams GV, Maton PN, Murphy GM, Saxton HM, Dowling RH, et al. Retrospective comparison of 'Cheno' and 'Urso' in the medical treatment of gallstones. Gut 1982; 23: 382-9.
  47. Tazuma S, Sasaki H, Mizuno S, Sagawa H, Hashiba S, Horiuchi I, et al. Effect of ursodeoxycholic acid administration on nucleation time in human gallbladder bile. Gastrenterology 1989; 97: 173-8. · DOI
  48. Jungst D, Brenner G, Pratschke E, Paumgartner G. Low-dose ursodeoxycholic acid prolongs cholesterol nucleation time in gallbladder bile of patients with cholesterol gallstones. JrHepatol 1989; 8: 1-6. · DOI
  49. Marks JW, Lan S-P, the Steering Committee and the National Cooperative Gallstone Study Group. Low-dose chenodiol to prevent gallstone recurrence after dissolution therapy. Ann Intern Med 1984; 100: 376-81. · DOI
  50. O'Donnell LDJ, Heaton KW. Recurrence and re-recurrence of gallstones after medical dissolution; long term follow up. Gut 1988; 29: 655-8. · DOI
  51. Cooperberg PL, Burhenne I. Real-time ultrasonography, diagnostic technique of choice in calculous gallbladder disease. NEnglJMed 1980; 302: 1277-9. · DOI
  52. Krook PM, Allen FH, Bush WH, et al. Comparison of real time cholecystosonography and oral cholecystectography. Radiology 1980; 135: 145-8. · DOI
  53. Nervi F, Couvarrubias C, Bravo P, et al. Influence of legume intake on biliary lipids and cholesterol saturation in young Chilean men. Gastroenterology 1989; 96: 825-30.
  54. Tint GS, Salen G, Chazen D. Symptomatic gallstones are likely to reoccur after dissolution with ursodeoxycholic acid (UDCA) but this may be prevented by low-dose UDCA [Abstract]. Gastroenterology 1987; 92: 1787.
  55. Sackman NM, Ippisch E, Sauerbruch T, Holl J, Brendel W, Paumgartner G. Early gallstone recurrence rate after successful shock-wave therapy. Gastroenterology 1990; 98: 392-6. · DOI
  56. Schoenfield LJ, Carulli N, Dowling RH, Sama C, Wolpers C. Asymptomatic gallstones: definition and treatment. Gastroenterol Int 1989; 2: 25-9.
  57. Paumgartner G, Carr-Locke DL, Roda E, Thistle JL. Biliary stones: non-surgical therapeutic approach. Gastroenterol Int 1988; 1:17-24.

Cited by

Sorted by citations

Metadata

Authors
Hood, K. A., Gleeson, D., Ruppin, D. C., & Dowling, R. H.
Venue
Gut
Publisher
BMJ
Published
1993-09
Volume
34
Issue
9
Pages
1277-1288
ISSN
  • 0017-5749
  • 1468-3288
DOI
10.1136/gut.34.9.1277
Cited by
34
References
0
Language
en

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review