Thank you!
I don’t feel bad. And that was my only attack—I think over the past few years I’ve had two flareups that I thought were heartburn. But if this is all I have right now, I can go on like this forever.
Do you know what the deal is with the drug udosil (Sp)? They say it can reduce gallstones, but it doesn’t seem to be the first choice.
3 medical options include:
1. Contact dissolution: performed by direct needle puncture of the gallbladder. Methyl tert-butyl ether (MTBE), a potent cholesterol solvent works in 65%, but 70% recur at 4yrs (Dig Dis Sci 1995;40:1775). Passage of the solvent into the duodenum can result in excessive absorption, leading to drowsiness, confusion, and anesthesia.
2. Extracorporeal shock-wave lithotripsy (ESWL): works in 80%, but 70% recur. Only 20% of pt’s qualify as can be used only if <1 radiolucent stone <20mm D with a patent duct, a normal functioning gallbladder, and mild sx’s. Contra if: coagulation and platelet abnormalities, cystic or vascular abnormalities of the liver, acute gallstone-related complications, pregnancy.
3. Oral bile salt therapy: Optimal for small stone size (<1 cm), mild sx’s, normal gallbladder function (normal filling and emptying), buoyant stones on oral cholecystography (suggesting a high cholesterol content) and minimal calcification and low density on CT imaging. Typical use the bile acids, either chenodeoxycholic acid or ursodeoxycholic acid (UDCA). Work by inhibiting biliary secretion of cholesterol, increasing hepatic bile secretion, inhibiting the deposition of cholesterol into stones, and improving gallbladder emptying. All pure cholesterol stones dissolve, however, most gallstones have a mixed composition with calcium salts that limit the efficacy of this form of therapy. If only ideal pt’s are selected dissolution rates may exceed 90%, but <10% of pt’s fall into this category (Medicine 1982;61:86)….thus incomplete dissolution remains a significant problem