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Targets for current pharmacologic therapy in cholesterol gallstone disease Di Ciaula A; Wang DQ; Wang HH; Bonfrate L; Portincasa PGastroenterol Clin North Am 2010[Jun]; 39 (2): 245-64, viii-ixGallstone disease is a frequent condition throughout the world and, cholesterol stones are the most frequent form in Western countries. The standard treatment of symptomatic gallstone subjects is laparoscopic cholecystectomy. The selection of patients amenable for nonsurgical, medical therapy is of key importance; a careful analysis should consider the natural history of the disease and the overall costs of therapy. Only patients with mild symptoms and small, uncalcified cholesterol gallstones in a functioning gallbladder with a patent cystic duct are considered for oral litholysis by hydrophilic ursodeoxycholic acid, in the hope of achieving cholesterol desaturation of bile and progressive stone dissolution. Recent studies have raised the possibility that cholesterol-lowering agents that inhibit hepatic cholesterol synthesis (statins) or intestinal cholesterol absorption (ezetimibe), or drugs acting on specific nuclear receptors involved in cholesterol and bile acid homeostasis, may offer, alone or in combination, additional medical therapeutic tools for treating cholesterol gallstones. Recent perspectives on medical treatment of cholesterol gallstone disease are discussed in this article.|Azetidines/*therapeutic use[MESH]|Cholesterol/*metabolism[MESH]|Cholinergic Antagonists/*therapeutic use[MESH]|Ezetimibe[MESH]|Gallstones/*drug therapy/metabolism[MESH]|Humans[MESH]|Hydroxymethylglutaryl-CoA Reductase Inhibitors/*therapeutic use[MESH]|Intestinal Absorption/*drug effects[MESH]|Treatment Outcome[MESH] |
