Seven women with gallstones were given 0.75 to 4.5 g per day of chenodeoxycholic acid, a primary bile acid, to promote micellar solubilization of cholesterol in bile. In Case 1 three stones that had remained unchanged in size during six years of observations disappeared after six months of treatment. A single stone in Case 2 and multiple calculi in Cases 3 and 4 progressively grew smaller during 14 to 22 months of chenodeoxycholic acid administration. Gallstone size did not change in the other three.
Chenodeoxycholic acid and total bile acid pool sizes (measured in two patients), which were reduced before therapy, were markedly expanded by chenodeoxycholic acid, and the ratio of bile acids and lecithin to cholesterol in bile increased in all patients. Liver function and morphology remained normal; moderate dose-related diarrhea occurred. Chenodeoxycholic acid may offer medical treatment for cholesterol cholelithiasis in man.
Supported in part by research grants (AM-6908 and RR585) from the National Institutes of Health, Public Health Service, and by grants-in-aid from the Share Foundation. Kansas City, Mo., and Mead Johnson & Co., Evansville, Ind. (Dr. Danzinger is a Travelling Fellow of the R. S. McLaughlin Foundation, Toronto, Canada).
We are indehted to Linda Moskalik and Richard Tucker for technical assistance, to Paul J. Thomas, Ph.D., and our colleagues in the Department of Roentgenology, Drs. John R. Hodgson and Harley C. Carlson, for advice, to the Clinical Study Unit for co-operation, to Brian Hébut, of the Weddel Company, for assistance in making large supplies of chenodeoxycholic acid available for this investigation and to Dr. H. Dam for furnishing us with his original data on mole fractions of total bile acids, lecithin and cholesterol in his in vitro system