Portincasa P, Ciaula AD, Bonfrate L, Wang DQ. Therapy of gallstone disease: What it was, what it is, what it will be. World J Gastrointest Pharmacol Ther 2012; 3(2): 7-20 [PMID: 22577615 DOI: 10.4292/wjgpt.v3.i2.7]
Corresponding Author of This Article
Piero Portincasa, MD, PhD, Professor, Section of Internal Medicine, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Piazza Giulio Cesare 11, Policlinico, 70124 Bari, Italy. p.portincasa@semeiotica.uniba.it
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World J Gastrointest Pharmacol Ther. Apr 6, 2012; 3(2): 7-20 Published online Apr 6, 2012. doi: 10.4292/wjgpt.v3.i2.7
Therapy of gallstone disease: What it was, what it is, what it will be
Piero Portincasa, Agostino Di Ciaula, Leonilde Bonfrate, David QH Wang
Piero Portincasa, Leonilde Bonfrate, Department of Biomedical Sciences and Human Oncology, Clinica Medica “A. Murri”, University of Bari Medical School, Piazza Giulio Cesare 11, Policlinico, 70124 Bari, Italy
Agostino Di Ciaula, Division of Internal Medicine, Hospital of Bisceglie, via Bovio 279, 70052 Bisceglie (Bari), Italy
David QH Wang, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Edward Doisy Research Center, Saint Louis University School of Medicine, St. Louis, MO 63104, United States
Author contributions: All authors wrote this editorial and gave substantial contributions to conception and design; all authors drafted the article and revised it critically for important intellectual content; all authors gave final approval of the version to be published.
Supported by (in part) research grants from the Italian Ministry of University and Research (No. FIRB 2003 RBAU01RANB002); the Italian National Research Council (short-term mobility grant 2005); the University of Bari (grants No. ORBA09XZZT and No. ORBA08YHKX) (to Portincasa P); University of Bari (No. DR11598-2009); and the National Institutes of Health (US Public Health Service) (research grants No. DK54012 and No. DK73917) (to Wang DQH)
Correspondence to: Piero Portincasa, MD, PhD, Professor, Section of Internal Medicine, Department of Biomedical Sciences and Human Oncology, University of Bari Medical School, Piazza Giulio Cesare 11, Policlinico, 70124 Bari, Italy. p.portincasa@semeiotica.uniba.it
Telephone: +39-80-5478227 Fax: +39-80-5478232
Received: February 22, 2011 Revised: September 21, 2011 Accepted: September 28, 2011 Published online: April 6, 2012
Abstract
Cholesterol gallstone disease is a common clinical condition influenced by genetic factors, increasing age, female gender, and metabolic factors. Although laparoscopic cholecystectomy is currently considered the gold standard in treating patients with symptomatic gallstones, new perspectives regarding medical therapy of cholelithiasis are currently under discussion, also taking into account the pathogenesis of gallstones, the natural history of the disease and the analysis of the overall costs of therapy. A careful selection of patients may lead to successful non-surgical therapy in symptomatic subjects with a functioning gallbladder harboring small radiolucent stones. The classical oral litholysis by ursodeoxycholic acid has been recently paralleled by new experimental observations, suggesting that cholesterol-lowering agents which inhibit cholesterol synthesis (statins) or intestinal cholesterol absorption (ezetimibe), or drugs acting on specific nuclear receptors involved in cholesterol and bile acid homeostasis, might be proposed as additional approaches for treating cholesterol gallstones. In this review we discuss old, recent and future perspectives on medical treatment of cholesterol cholelithiasis.
