Terapia medica della litiasi colecistica Riflessioni critiche

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M. ANGELICO

Ann. Ital. Chir., LXIX, 6, 1998

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Gallbladder stones can be asymptomatic, symptomatic or complicated.
Medical therapy can be indicated only in patients
with symptomatic gallstones. Indications to medical therapy
is today limited by the knowledge of the benign natural history
of the disease and by the availability of new surgical techniques,
such as laparoscopic cholecystectomy. The ideal patient
to be treated by medical therapy is mildly symptomatic, non
obese, with functioning gallbladder and with radiolucent,
floating stones, not larger than 5 mm in diameter. This type
of patient represents only 3% of the population of gallstone
patients and has a 90% likelihood of having complete stone
dissolution after one year of treatment with ursodeoxycholic
acid (12 mg/kg of body weight/day). Medical treatment can
be proposed also in patients with stones up to 10 mm in diameter,
but the likelihood of complete dissolution after one
year drops to 60%, thus, treatment is indicated only in selected
or high-risk patients. Ursodeoxycholic acid therapy can
be useful in patients with biliary sludge or microlithiasis,
expecially if recently developed.

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