Seven patients with radiolucent stones in the gallbladder and two patients with radiolucent stones in the biliary tree were treated with oral cholic acid and purified soya-bean lecithin for 6 months. In two patients the stones disappeared and in one patient the stones were reduced in size. In five patients fasting bile samples were obtained before and during treatment and assayed for cholesterol, bile acid, and phospholipid. In all five patients the lithogenic index of bile was reduced during treatment. The biliary deoxycholic acid concentration was increased and chenodeoxycholic acid concentration decreased during treatment.
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deoxycholic acid. This is the same as changes seen after oral feeding with cholic acid alone.4 The increase in deoxycholic acid is probably due to dehydroxylation of cholic acid by bacteria in the gut, and the reduced pro- portion of chenodeoxycholic acid may be due to inhibi- tion of its hepatic synthesis by deoxycholic acid. It has been suggested that high concentrations of deoxycholic acid in bile increase the predisposition to cholesterol gallstones.15 However, deoxycholic acid is a very potent solvent of cholesterol gallstones in vitro and we have shown that the cholesterol saturation of bile is reduced and stones disappear in the presence of increased deoxy- cholic acid concentrations in bile. Our experience is limited to a few patients and treated for a short time. Studies with chenodeoxycholic-acid therapy take to 18 so final deter-have shown that dissolution of stones in the gallbladder may up months,2 mination of the value of cholic acid and lecithin will require more extended observation in further patients. This study was supported in part by a research grant from the National Health and Medical Research Council. J. T. held an N.H. & M.R.C. medical postgraduate research scholarship. The cholic acid was supplied by Weddel Pharmaceuticals Ltd, London, and the puri- fied soya-bean lecithin as was provided by Nattermann International GmbH, Cologne who also supported the work of P. J. We thank Dr J. Monk for the radiological interpretation, of Mrs H. Havlik and Miss help.S. Trotter, for technical assistance, and Mrs E. Stanley for secretarial