Gallstone disease medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hadeel Maksoud M.D.[2]


Patients with asymptomatic gallstones are usually not treated since the chances of complications developing in the future are low, however, patients with symptomatic gallstones can be treated medically, for example, with ursodeoxycholic acid. However, the mainstay of treatment for gallstone disease is surgically, especially since the introduction of laparoscopic cholecystectomy. Fibrates, including gemfibrozil and fenofibrates are an absolute contraindication in gallstone disease.

Medical therapy

  • Pharmacologic medical therapies for gallstone disease include either medical dissolution therapy or contact dissolution therapy.[1][2]
  • Cholesterol gallstones can sometimes be dissolved by oral ursodeoxycholic acid.
  • Nonsurgical approaches are used only in special situations such as when a patient has a serious medical condition preventing surgery and only then for cholesterol stones.
  • Stones commonly recur within 5 years in patients treated non-surgically.


  • 1 Gallstone disease
    • 1.1 Biliary tract
      • 1.1.1 Adult
        • Gall stone dissolution
          • Preferred regimen (1): Ursodiol PO 8-10 mg/kg q24h in 2-3 divided doses (Max up to 24 months)
        • Gall stone prevention
          • Preferred regimen (1): Ursodiol PO 300 mg q12h
        • Primary biliary cirrhosis
          • Preferred regimen (3): (Urso, Urso forte): Oral: 13-15 mg/kg/day in 2-4 divided doses (with food)
      • 1.1.2 Pediatric
        • Children < 8 years of age
          • Preferred regimen (1):In parenteral nutrition-induced cholestasis in neonates, some experts recommend: Oral: 30 mg/kg/day in 2- 3 divided doses
        • Children > 8 years of age
        • Gall stone dissolution
          • Preferred regimen (1): Ursodiol PO 25 mg/kg q24h (Max up to 13 months)
  • 2 Other medical therapies[11][12][13][14][15]
  • 3 Biliary colic treatment[16][17][18][19]

Contraindicated medications

  • Gallstones are considered an absolute contraindication to the use of the following medications:


  1. Darzi A, Geraghty JG, Williams NN, Sheehan SS, Tanner AN, Keane FB (1994). "The pros and cons of laparoscopic cholecystectomy and extracorporeal shock wave lithotripsy in the management of gallstone disease". Ann R Coll Surg Engl. 76 (1): 42–6. PMC 2502162. PMID 8054014.
  2. Portincasa P, van de Meeberg P, van Erpecum KJ, Palasciano G, VanBerge-Henegouwen GP (1997). "An update on the pathogenesis and treatment of cholesterol gallstones". Scand. J. Gastroenterol. Suppl. 223: 60–9. PMID 9200309.
  3. Rubin RA, Kowalski TE, Khandelwal M, Malet PF (1994). "Ursodiol for hepatobiliary disorders". Ann. Intern. Med. 121 (3): 207–18. PMID 8017748.
  4. Guarino MP, Cong P, Cicala M, Alloni R, Carotti S, Behar J (2007). "Ursodeoxycholic acid improves muscle contractility and inflammation in symptomatic gallbladders with cholesterol gallstones". Gut. 56 (6): 815–20. doi:10.1136/gut.2006.109934. PMC 1954869. PMID 17185355.
  5. Hardison WG, Grundy SM (1984). "Effect of ursodeoxycholate and its taurine conjugate on bile acid synthesis and cholesterol absorption". Gastroenterology. 87 (1): 130–5. PMID 6724255.
  6. Uchida K, Akiyoshi T, Igimi H, Takase H, Nomura Y, Ishihara S (1991). "Differential effects of ursodeoxycholic acid and ursocholic acid on the formation of biliary cholesterol crystals in mice". Lipids. 26 (7): 526–30. PMID 1943496.
  7. van de Heijning BJ, van de Meeberg PC, Portincasa P, Doornewaard H, Hoebers FJ, van Erpecum KJ, Vanberge-Henegouwen GP (1999). "Effects of ursodeoxycholic acid therapy on in vitro gallbladder contractility in patients with cholesterol gallstones". Dig. Dis. Sci. 44 (1): 190–6. PMID 9952243.
  8. Ward A, Brogden RN, Heel RC, Speight TM, Avery GS (1984). "Ursodeoxycholic acid: a review of its pharmacological properties and therapeutic efficacy". Drugs. 27 (2): 95–131. PMID 6365507.
  9. Bachrach WH, Hofmann AF (1982). "Ursodeoxycholic acid in the treatment of cholesterol cholelithiasis. part I". Dig. Dis. Sci. 27 (8): 737–61. PMID 7094795.
  10. Bachrach WH, Hofmann AF (1982). "Ursodeoxycholic acid in the treatment of cholesterol cholelithiasis. Part II". Dig. Dis. Sci. 27 (9): 833–56. PMID 7049627.
  11. Saunders KD, Cates JA, Abedin MZ, Roslyn JJ (1993). "Lovastatin and gallstone dissolution: a preliminary study". Surgery. 113 (1): 28–35. PMID 8417484.
  12. Chapman BA, Burt MJ, Chisholm RJ, Allan RB, Yeo KH, Ross AG (1998). "Dissolution of gallstones with simvastatin, an HMG CoA reductase inhibitor". Dig. Dis. Sci. 43 (2): 349–53. PMID 9512129.
  13. de Bari O, Wang HH, Portincasa P, Paik CN, Liu M, Wang DQ (2014). "Ezetimibe prevents the formation of oestrogen-induced cholesterol gallstones in mice". Eur. J. Clin. Invest. 44 (12): 1159–68. doi:10.1111/eci.12350. PMC 4659711. PMID 25303682.
  14. Doran J, Keighley MR, Bell GD (1979). "Rowachol--a possible treatment for cholesterol gallstones". Gut. 20 (4): 312–7. PMC 1412390. PMID 447112.
  15. Ellis WR, Somerville KW, Whitten BH, Bell GD (1984). "Pilot study of combination treatment for gall stones with medium dose chenodeoxycholic acid and a terpene preparation". Br Med J (Clin Res Ed). 289 (6438): 153–6. PMC 1442019. PMID 6430390.
  16. "BestBets: Buscopan (hyoscine butylbromide) in biliary colic".
  17. Colli A, Conte D, Valle SD, Sciola V, Fraquelli M (2012). "Meta-analysis: nonsteroidal anti-inflammatory drugs in biliary colic". Aliment. Pharmacol. Ther. 35 (12): 1370–8. doi:10.1111/j.1365-2036.2012.05115.x. PMID 22540869.
  18. Henderson SO, Swadron S, Newton E (2002). "Comparison of intravenous ketorolac and meperidine in the treatment of biliary colic". J Emerg Med. 23 (3): 237–41. PMID 12426013.
  19. Akriviadis EA, Hatzigavriel M, Kapnias D, Kirimlidis J, Markantas A, Garyfallos A (1997). "Treatment of biliary colic with diclofenac: a randomized, double-blind, placebo-controlled study". Gastroenterology. 113 (1): 225–31. PMID 9207282.

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