Question explored with the scientific record
Conversation so far
- 1 Is there any way to naturally remove gall bladder stones
- 2 How do I know if my stones are the dissolvable type for UDCA?
Answered on this page ↓
How do I know if my stones are the dissolvable type for UDCA?
The short version: you cannot know for certain without imaging, but the odds are best for small, radiolucent stones in a working gallbladder.
UDCA only dissolves cholesterol-predominant stones. The evidence shows that radiolucent stones on X-ray are the target [3, 5]. A 1988 study found that calcium carbonate shells, which resist dissolution, are common even in cholesterol stones [13]. CT imaging can help: dense or rimmed stones on CT have lower cholesterol content and higher calcium, making them poor candidates [18]. Ultrasound alone cannot reliably tell you the composition [25].
Your gallbladder must also function. The 1977 trials that showed dissolution required a functioning gallbladder [3, 5]. If your gallbladder does not empty well, UDCA has little chance of working.
| Stone type | Imaging clue | UDCA likely to work? |
|---|---|---|
| Pure cholesterol | Radiolucent on X-ray, isodense on CT | Yes |
| Mixed with calcium shell | Rimmed or dense on CT | No |
| Pigment stone | Dense on CT | No |
The evidence is old, mostly from the 1970s and 1980s, and the trials were small [3, 5]. No modern trial has re-tested these criteria.
My call: ask for a plain X-ray and a CT scan to check for calcification before committing to UDCA. Confidence: moderate.
Sources examined 31
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Ursodeoxycholic acid and cholesterol induce enterohepatic cycling of bilirubin in rodents
This study investigates how oral administration of ursodeoxycholic acid (UDCA) and cholesterol affects enterohepatic cycling of bilirubin in rodents, demonstrating that both substances significantly increase bilirubin secretion rates into bile through bile salt malabsorption.
DOI: 10.1016/s0016-5085(98)70152-0 -
Rowachol and Ursodeoxycholic Acid in Hamsters with Cholesterol Gallstones
This study compares the effects of Rowachol, a mixture of terpenes, and Ursodeoxycholic Acid (UDCA) on cholesterol gallstone dissolution in hamsters, finding that while UDCA prevented gallstone formation, Rowachol did not dissolve gallstones or alter bile composition significant…
DOI: 10.1097/00000441-198211000-00003 -
DISSOLUTION OF CHOLESTEROL GALLSTONES BY URSODEOXYCHOLIC ACID
This study demonstrates that ursodeoxycholic acid (UDCA) is effective in dissolving cholesterol gallstones in patients, with a notable success rate and no observed hepatotoxicity.
DOI: 10.1016/s0140-6736(77)90301-4 -
Effect of ursodeoxycholic acid administration on biliary lipid composition and bile acid kinetics in cholesterol gallstone patients
This study evaluates the effects of ursodeoxycholic acid (UDCA) on bile lipid composition and bile acid kinetics in seven cholesterol gallstone patients, finding that UDCA significantly reduces the cholesterol saturation index and alters bile acid pools, suggesting its potential…
DOI: 10.1007/BF01324739 -
Clinical studies on dissolution of gallstones using ursodeoxycholic acid
This study evaluates the clinical effectiveness of Ursodeoxycholic acid (UDCA) in dissolving cholesterol gallstones in 74 patients, reporting a 43% overall effectiveness rate with minimal side effects.
DOI: 10.1007/BF02781340 -
Role of bile acids in atherogenesis: review
Bile acids regulate cholesterol metabolism and atherogenesis, and ursodeoxycholic acid (UDCA) emerges as a therapeutic option that can improve lipid profiles and liver health to potentially reduce cardiovascular risk, particularly in NAFLD and cholestatic contexts.
DOI: 10.15829/1728-8800-2024-4126 -
Effect of ursodeoxycholic acid on inflammatory infiltrate in gallbladder muscle of cholesterol gallstone patients
This study investigates the effects of ursodeoxycholic acid (UDCA) on inflammatory infiltrates in the gallbladder muscle of patients with cholesterol gallstones, revealing that UDCA treatment significantly reduces the presence of inflammatory cells and mediators associated with …
DOI: 10.1111/j.1365-2982.2010.01510.x -
Serum cholestanol, cholesterol precursors, and plant sterols during placebo-controlled treatment of primary biliary cirrhosis with ursodeoxycholic acid or colchicine*1
This study investigates the effects of ursodeoxycholic acid (URSO) and colchicine on serum lipids, cholesterol precursors, cholestanol, and plant sterols in patients with primary biliary cirrhosis (PBC) over a two-year period, revealing that both treatments improve liver functio…
DOI: 10.1016/0270-9139(95)90046-2 -
Effect of Ursodeoxycholic Acid on Serum Lipids of Patients With Primary Biliary Cirrhosis
This study investigates the long-term effects of ursodeoxycholic acid (UDCA) on serum lipid levels in patients with primary biliary cirrhosis (PBC), finding significant reductions in total cholesterol levels without affecting triglycerides or HDL cholesterol.
DOI: 10.1016/s0025-6196(12)61815-1 -
Biological and Medical Aspects of Active Heal Transport of Bile Acids
A comprehensive review of the ileal bile acid transport system (IBATS) and its role in enterohepatic circulation, detailing its high-capacity/low-affinity Na+-dependent transport, its negative feedback regulation by bile acids, implications for bile acid malabsorption, cholestas…
DOI: 10.3109/07853899109148043 -
Cholesterol gallstone disease
A comprehensive 2006 Lancet review outlining the pathophysiology, genetics, epidemiology, and clinical management of cholesterol gallstone disease, emphasizing liver–gallbladder–intestine interactions, regulatory bile acid/lipid pathways, genetic determinants, dietary factors, a…
DOI: 10.1016/s0140-6736(06)69044-2 -
Physical-chemical properties of chenodeoxycholic acid and ursodeoxycholic acid
This study investigates the physical-chemical properties of chenodeoxycholic acid (CDCA) and ursodeoxycholic acid (UDCA), revealing significant differences in their critical micellar concentration, micellar molecular weight, and cholesterol solubilization efficiency, which may i…
DOI: 10.1007/BF02774276 -
Calcium carbonate in cholesterol gallstones
This study analyzes twelve cholesterol gallstones to identify calcium carbonate polymorphs (calcite, vaterite, aragonite) and carbonate-apatite, maps their peripheral localization and association with pigments, and discusses how CaCO3-rich peripheries may contribute to resistanc…
DOI: 10.1016/s0168-8278(88)80464-1 -
Atorvastatin in patients with primary biliary cirrhosis and incomplete biochemical response to ursodeoxycholic acid
This study investigates the effects of atorvastatin on serum markers of cholestasis and lipid metabolism in patients with primary biliary cirrhosis who have an incomplete biochemical response to ursodeoxycholic acid, finding that atorvastatin does not improve cholestasis but eff…
DOI: 10.1002/hep.21741 -
Medical treatment of biliary duct stones: effect of ursodeoxycholic acid administration.
A randomized double-masked trial in 28 patients with radiolucent biliary duct stones showed that oral ursodeoxycholic acid (UDCA) dissolved stones in a majority of treated patients, reduced cholestatic symptoms and alkaline phosphatase, altered bile composition by markedly incre…
DOI: 10.1136/gut.24.7.609 -
Ursodeoxycholic Acid, 7-Ketolithocholic Acid, and Chenodeoxycholic Acid Are Primary Bile Acids of the Nutria (Myocastor copus)
This study investigates the synthesis and interconversion of primary bile acids, specifically ursodeoxycholic acid, 7-ketolithocholic acid, and chenodeoxycholic acid, in the nutria (Myocastor coypus), demonstrating their hepatic synthesis from cholesterol and the influence of in…
DOI: 10.1016/0016-5085(86)91126-1 -
The role of 99mTc mebrofenin hepatobiliary scanning in predicting common bile duct stones in patients with gallstone disease
99mTc mebrofenin hepatobiliary scintigraphy demonstrated 80% sensitivity and 80% specificity for predicting common bile duct stones in gallstone disease, suggesting a non-invasive preoperative screen for CBD stones when MRCP is unavailable.
DOI: 10.1097/00006231-200403000-00012 -
CT evaluation of gallstones in vitro: correlation with chemical analysis
This study evaluates the correlation between the CT appearance and chemical composition of gallstones, revealing that CT imaging can effectively differentiate between high and low cholesterol content stones based on their visual characteristics.
DOI: 10.2214/ajr.151.6.1123 -
Magnetic resonance imaging for the visualization of cholesterol gallstones in hamster fed a new high sucrose lithogenic diet
The study develops a high-field MRI method with chemical shift imaging to noninvasively visualize cholesterol gallstones in living hamsters fed a new high-sucrose lithogenic diet, validates MRI against surgical observation, and shows the diet induces gallstones in about half of …
DOI: 10.1016/0168-8278(95)80114-6 -
Gallbladder Dysfunction: Cholecystitis, Choledocholithiasis, Cholangitis, and Biliary Dyskinesia
A clinical review outlining gallbladder disease (acute cholecystitis, choledocholithiasis, cholangitis, biliary dyskinesia), its epidemiology, diagnostic imaging modalities, and current management guidelines including Tokyo Guidelines and imaging/test performance, with practical…
DOI: 10.1016/j.pop.2017.07.002 -
The Management of Common Bile Duct Stones
This article reviews the prevalence, diagnosis, and management of common bile duct stones, comparing imaging modalities (EUS, MRCP) and treatment options (ERCP with biliary clearance vs. single-stage laparoscopic CBD exploration with cholecystectomy), and proposes an evidence-ba…
DOI: 10.4166/kjg.2018.71.5.260 -
Gallstone extracorporeal shock-wave lithotripsy: time and treatment considerations.
A prospective study of 27 patients undergoing 30 gallstone ESWL procedures with the Dornier MPL-9000 to quantify time in the lithotripsy suite (pretreatment, treatment, posttreatment) and interruptions during shock-wave delivery, revealing an average total time of 98 ± 32 minute…
DOI: 10.2214/ajr.154.2.2105016 -
The mechanisms of stone disintegration by shock waves
High-speed imaging shows shock waves fracture stones by creating fissures that are exploited by collapsing cavitation bubbles inside those cracks to drive fragmentation, with mucus infiltration between shocks proposed to enhance cavitation and fragmentation.
DOI: 10.1016/0301-5629(91)90045-x -
Spontaneous disappearance of large stones from the common bile duct
This case report describes the spontaneous disappearance of three large gallstones from the common bile duct in a 68-year-old male patient, emphasizing the need for repeat diagnostic imaging in asymptomatic patients before planned surgery.
DOI: 10.1007/BF01888599 -
Ultrasonic properties of biliary calculi.
This study investigates the intrinsic ultrasonic attenuation of gallstones and its correlation with shadowing effects observed in ultrasound imaging, revealing that higher attenuation is associated with more crystalline structures and recommending the use of higher-frequency tra…
DOI: 10.1148/radiology.136.3.7403555 -
MR cholangiopancreatography using HASTE sequences
A pictorial review evaluating HASTE-based MRCP for noninvasive biliary and pancreatic duct imaging, demonstrating high sensitivity for biliary obstruction, gallstones, and acute cholecystitis in 350 patients and advocating breath-hold, multi-planar MR imaging as an ERCP alternat…
DOI: 10.1016/S0009-9260(99)90020-X -
Spilled Gallstones after Laparoscopic Cholecystectomy
Spilled gallstones during laparoscopic cholecystectomy can cause delayed abscesses; in a 77-year-old woman, retained stones led to a right flank abscess treated with percutaneous drainage and subsequent open removal, while literature suggests diverse abscess locations and stress…
DOI: 10.1089/109264202320884144 -
Automatic gallbladder and gallstone regions segmentation in ultrasound image
This study presents a novel automatic segmentation method for gallbladder and gallstone regions in ultrasound images, achieving high accuracy and efficiency compared to existing semi-automatic methods.
DOI: 10.1007/s11548-016-1515-z -
Combined cholecystectomy in gastric cancer surgery
A retrospective study of 445 gastric cancer patients evaluating whether adding cholecystectomy during gastrectomy for asymptomatic gallstones affects surgical morbidity, mortality, and long-term survival, and assessing the risk of subsequent gallbladder disease after gastrectomy.
DOI: 10.1016/j.ijsu.2013.02.006 -
Clinical value of spectral CT in diagnosis of negative gallstones and common bile duct stones
This study investigates the clinical value of spectral CT in diagnosing negative gallstones and common bile duct stones, demonstrating its superior diagnostic capabilities compared to conventional CT methods.
DOI: 10.1007/s00261-015-0387-y -
Ultrasonic studies of gall-bladder stones
This study evaluates the ultrasonic properties of gallstones to inform the design of a non-surgical disintegrator for treating gallstone disease.
DOI: 10.1016/0041-624x(89)90023-1