Re: Bile Stones

[Guest guest]

I can't answer your question Sandi, but I can't believe you are still awake, are you practicing for Chicago so you won't miss anything?????

Bettyann

[Guest guest]

I can't answer your question Sandi, but I can't believe you are still awake, are you practicing for Chicago so you won't miss anything?????

Bettyann

[Guest guest]

Hi Sandi;

Bile stones (and gall stones) can form when bile becomes supersaturated with

cholesterol. Ursodeoxycholic acid in part prevents gallstones and bile stone

formation by lowering biliary cholesterol and therefore preventing

supersaturation of the bile. It is also thins the bile and allows for gallstones

and bile stone dissolution.

If you were on ursodiol for a while and then taken off of it, you might predict;

a thickening of the bile, an increase of cholesterol in the bile, and increased

risk of cholesterol bile stone and gallstone formation.

This is what worries me about taking everyone off of ursodiol.

_________________________

Am J Surg. 1989 Sep;158(3):198-204.

Medical dissolution of gallstones by oral bile acid therapy.

Hofmann AF

Department of Medicine, University of California, San Diego, La Jolla

92093-0813.

The rationale, safety, and efficacy of cholesterol gallstone dissolution by

orally administered ursodiol, chenodiol, or a combination of the two agents are

summarized herein. Bile must be supersaturated in cholesterol for gallstones to

form, and desaturation of bile by orally administered bile acids induces gradual

stone dissolution. The mechanism of action of the two agents differs, but both

cause a decreased input of cholesterol into the metabolic pool. Ursodiol is free

of side effects, and the combination with chenodiol is equally efficacious and

also has few side effects. Chenodiol, although an effective desaturation agent,

causes diarrhea, mild reversible hepatic injury, and a small increase in the

plasma cholesterol level. Extracorporeal shock-wave lithotripsy decreases

gallstone size markedly and thereby increases the speed of dissolution by orally

administered bile acids. Medical therapy with oral bile acids is appropriate for

patients who present with small cholesterol stones and for patients with larger

cholesterol gallstones who cannot or will not have surgery. Oral bile acids may

also be valuable in the treatment of gallstone recurrence before it has become

symptomatic or to prevent recurrence after prior successful dissolution of

recurrent stones. PMID: 2672842.

_________________________

Dave

(father of (23); PSC 07/03; UC 08/03)

[Guest guest]

Hi Sandi;

Bile stones (and gall stones) can form when bile becomes supersaturated with

cholesterol. Ursodeoxycholic acid in part prevents gallstones and bile stone

formation by lowering biliary cholesterol and therefore preventing

supersaturation of the bile. It is also thins the bile and allows for gallstones

and bile stone dissolution.

If you were on ursodiol for a while and then taken off of it, you might predict;

a thickening of the bile, an increase of cholesterol in the bile, and increased

risk of cholesterol bile stone and gallstone formation.

This is what worries me about taking everyone off of ursodiol.

_________________________

Am J Surg. 1989 Sep;158(3):198-204.

Medical dissolution of gallstones by oral bile acid therapy.

Hofmann AF

Department of Medicine, University of California, San Diego, La Jolla

92093-0813.

The rationale, safety, and efficacy of cholesterol gallstone dissolution by

orally administered ursodiol, chenodiol, or a combination of the two agents are

summarized herein. Bile must be supersaturated in cholesterol for gallstones to

form, and desaturation of bile by orally administered bile acids induces gradual

stone dissolution. The mechanism of action of the two agents differs, but both

cause a decreased input of cholesterol into the metabolic pool. Ursodiol is free

of side effects, and the combination with chenodiol is equally efficacious and

also has few side effects. Chenodiol, although an effective desaturation agent,

causes diarrhea, mild reversible hepatic injury, and a small increase in the

plasma cholesterol level. Extracorporeal shock-wave lithotripsy decreases

gallstone size markedly and thereby increases the speed of dissolution by orally

administered bile acids. Medical therapy with oral bile acids is appropriate for

patients who present with small cholesterol stones and for patients with larger

cholesterol gallstones who cannot or will not have surgery. Oral bile acids may

also be valuable in the treatment of gallstone recurrence before it has become

symptomatic or to prevent recurrence after prior successful dissolution of

recurrent stones. PMID: 2672842.

_________________________

Dave

(father of (23); PSC 07/03; UC 08/03)

[Guest guest]

Hi Sandi;

Bile stones (and gall stones) can form when bile becomes supersaturated with

cholesterol. Ursodeoxycholic acid in part prevents gallstones and bile stone

formation by lowering biliary cholesterol and therefore preventing

supersaturation of the bile. It is also thins the bile and allows for gallstones

and bile stone dissolution.

If you were on ursodiol for a while and then taken off of it, you might predict;

a thickening of the bile, an increase of cholesterol in the bile, and increased

risk of cholesterol bile stone and gallstone formation.

This is what worries me about taking everyone off of ursodiol.

_________________________

Am J Surg. 1989 Sep;158(3):198-204.

Medical dissolution of gallstones by oral bile acid therapy.

Hofmann AF

Department of Medicine, University of California, San Diego, La Jolla

92093-0813.

The rationale, safety, and efficacy of cholesterol gallstone dissolution by

orally administered ursodiol, chenodiol, or a combination of the two agents are

summarized herein. Bile must be supersaturated in cholesterol for gallstones to

form, and desaturation of bile by orally administered bile acids induces gradual

stone dissolution. The mechanism of action of the two agents differs, but both

cause a decreased input of cholesterol into the metabolic pool. Ursodiol is free

of side effects, and the combination with chenodiol is equally efficacious and

also has few side effects. Chenodiol, although an effective desaturation agent,

causes diarrhea, mild reversible hepatic injury, and a small increase in the

plasma cholesterol level. Extracorporeal shock-wave lithotripsy decreases

gallstone size markedly and thereby increases the speed of dissolution by orally

administered bile acids. Medical therapy with oral bile acids is appropriate for

patients who present with small cholesterol stones and for patients with larger

cholesterol gallstones who cannot or will not have surgery. Oral bile acids may

also be valuable in the treatment of gallstone recurrence before it has become

symptomatic or to prevent recurrence after prior successful dissolution of

recurrent stones. PMID: 2672842.

_________________________

Dave

(father of (23); PSC 07/03; UC 08/03)

[Guest guest]

Original Message:

Bile stones (and gall stones) can form when bile becomes supersaturated with

cholesterol. Ursodeoxycholic acid in part prevents gallstones and bile stone

formation by lowering biliary cholesterol and therefore preventing

supersaturation of the bile. It is also thins the bile and allows for

gallstones and bile stone dissolution.

If you were on ursodiol for a while and then taken off of it, you might

predict; a thickening of the bile, an increase of cholesterol in the bile, and

increased risk of cholesterol bile stone and gallstone formation.

,

Thank you for the answer.

My case is a little different because I had

been on Urso for seventeen years without a break. In 7/07 I had my gall

bladder removed due to polyps and wasting. Shortly thereafter I developed

a bile stone that blocked my bile duct. Could it have been in my system

for some time and when my gall bladder was removed it triggered it to move into

the bile duct?

This directly led to my transplant. I

am not unhappy that I was transplanted; I would like to understand more.

Also, what are your thoughts on URSO post

transplant? I was taken off, but I know others who remained on it.

[Guest guest]

Original Message:

Bile stones (and gall stones) can form when bile becomes supersaturated with

cholesterol. Ursodeoxycholic acid in part prevents gallstones and bile stone

formation by lowering biliary cholesterol and therefore preventing

supersaturation of the bile. It is also thins the bile and allows for

gallstones and bile stone dissolution.

If you were on ursodiol for a while and then taken off of it, you might

predict; a thickening of the bile, an increase of cholesterol in the bile, and

increased risk of cholesterol bile stone and gallstone formation.

,

Thank you for the answer.

My case is a little different because I had

been on Urso for seventeen years without a break. In 7/07 I had my gall

bladder removed due to polyps and wasting. Shortly thereafter I developed

a bile stone that blocked my bile duct. Could it have been in my system

for some time and when my gall bladder was removed it triggered it to move into

the bile duct?

This directly led to my transplant. I

am not unhappy that I was transplanted; I would like to understand more.

Also, what are your thoughts on URSO post

transplant? I was taken off, but I know others who remained on it.

[Guest guest]

Original Message:

Bile stones (and gall stones) can form when bile becomes supersaturated with

cholesterol. Ursodeoxycholic acid in part prevents gallstones and bile stone

formation by lowering biliary cholesterol and therefore preventing

supersaturation of the bile. It is also thins the bile and allows for

gallstones and bile stone dissolution.

If you were on ursodiol for a while and then taken off of it, you might

predict; a thickening of the bile, an increase of cholesterol in the bile, and

increased risk of cholesterol bile stone and gallstone formation.

,

Thank you for the answer.

My case is a little different because I had

been on Urso for seventeen years without a break. In 7/07 I had my gall

bladder removed due to polyps and wasting. Shortly thereafter I developed

a bile stone that blocked my bile duct. Could it have been in my system

for some time and when my gall bladder was removed it triggered it to move into

the bile duct?

This directly led to my transplant. I

am not unhappy that I was transplanted; I would like to understand more.

Also, what are your thoughts on URSO post

transplant? I was taken off, but I know others who remained on it.

[Guest guest]

Dave,Hi!  Thanks for the explanation.  I wasn't actually taken off the Ursodiol until about a week before they found the stones.  I'd been on high dose for several years prior to that.  Would that lag time be enough time for the stones to form or would they have had to have been there all along?  Any idea?  Also, they say my cholesterol level is fine.  Is this a different type of cholesterol?Thanks!  Sandi

[Guest guest]

Sandi,

I was on high dose Urso from 2000 up to tx in Nov. 07. In the last 2 ERCP's prior to tx they found bile stones - lots of them. It was those ERCPs that made up the docs mind that tx was in my near future. So at least in my expereince the Urso didn't prevent the stones but I do think the Urso did help me postpone tx for several years.

Blessings,

Barby - KS

Subject: Re: Re: Bile StonesTo: Date: Wednesday, April 8, 2009, 12:26 PM

Dave,

Hi! Thanks for the explanation. I wasn't actually taken off the Ursodiol until about a week before they found the stones. I'd been on high dose for several years prior to that. Would that lag time be enough time for the stones to form or would they have had to have been there all along? Any idea? Also, they say my cholesterol level is fine. Is this a different type of cholesterol?

Thanks!

Sandi

[Guest guest]

Sandi,

I was on high dose Urso from 2000 up to tx in Nov. 07. In the last 2 ERCP's prior to tx they found bile stones - lots of them. It was those ERCPs that made up the docs mind that tx was in my near future. So at least in my expereince the Urso didn't prevent the stones but I do think the Urso did help me postpone tx for several years.

Blessings,

Barby - KS

Subject: Re: Re: Bile StonesTo: Date: Wednesday, April 8, 2009, 12:26 PM

Dave,

Hi! Thanks for the explanation. I wasn't actually taken off the Ursodiol until about a week before they found the stones. I'd been on high dose for several years prior to that. Would that lag time be enough time for the stones to form or would they have had to have been there all along? Any idea? Also, they say my cholesterol level is fine. Is this a different type of cholesterol?

Thanks!

Sandi

[Guest guest]

Sandi,

I was on high dose Urso from 2000 up to tx in Nov. 07. In the last 2 ERCP's prior to tx they found bile stones - lots of them. It was those ERCPs that made up the docs mind that tx was in my near future. So at least in my expereince the Urso didn't prevent the stones but I do think the Urso did help me postpone tx for several years.

Blessings,

Barby - KS

Subject: Re: Re: Bile StonesTo: Date: Wednesday, April 8, 2009, 12:26 PM

Dave,

Hi! Thanks for the explanation. I wasn't actually taken off the Ursodiol until about a week before they found the stones. I'd been on high dose for several years prior to that. Would that lag time be enough time for the stones to form or would they have had to have been there all along? Any idea? Also, they say my cholesterol level is fine. Is this a different type of cholesterol?

Thanks!

Sandi

[Guest guest]

Original post:

So at least in my expereince the Urso didn't prevent

the stones but I do think the Urso did help me postpone tx for several years.

I agree. Urso was a positive for

me. I stayed symptom free for many years while on Urso. Prior to starting

it I had regular symptoms.

[Guest guest]

Hi Sandi;

I honestly don't know about how long it would take for stones to form after

being taken off of ursodiol, and whether the 7 day period you describe would be

enough time. It depends a lot on how big the stones were, and you have not

provided any information about that. If they were quite small (like grains of

sand), I suppose they could form quite quickly. Did your doctor give you any

indications of their size?

It's known that when starting on ursodiol for the first time " the proportion of

total biliary bile salts comprised by ursodiol increases within 1 to 2 weeks

from 1% to a maximum of approximately 60% " :

http://www.annals.org/cgi/content/full/121/3/207

So it is likely that doing the opposite (i.e. being taken off ursodiol) could

cause the percent ursodiol in the bile to decrease from 60% to 1% within 1 to 2

weeks.

Ursodiol is important for dissolving cholesterol gallstones because it is more

hydrophilic (water-loving) than the more hydrophobic (water-fearing) bile salts

often accumulated in the bile in cholestatic liver diseases. The cholesterol has

a harder time precipitating out of solution in a hydrophilic bile containing

ursodiol than in a hydrophobic bile that is deficient in ursodiol. Moreover the

cholesterol more readily dissolves in a hydrophilic bile containing ursodiol

than in a hydrophobic bile that is deficient in ursodiol.

As I mentioned earlier, biliary cholesterol supersaturation is the main problem

in gallstone and bile stone formation, and ursodiol therapy also inhibits

cholesterol synthesis in the liver, thereby lowering the cholesterol content of

the bile. The biliary concentration of cholesterol is probably not closely

related to your total serum cholesterol. Thus, biliary concentration of

cholesterol could possibly go up without this showing up in your total serum

cholesterol level during the short-term.

Best regards,

Dave

(father of (23)

>

> Dave,

> Hi!  Thanks for the explanation.  I wasn't actually taken off the Ursodiol

until about a week before they found the stones.  I'd been on high dose for

several years prior to that.  Would that lag time be enough time for the stones

to form or would they have had to have been there all along?  Any idea?  Also,

they say my cholesterol level is fine.  Is this a different type of cholesterol?

> Thanks!  

> Sandi

>

[Guest guest]

Hi Sandi;

I honestly don't know about how long it would take for stones to form after

being taken off of ursodiol, and whether the 7 day period you describe would be

enough time. It depends a lot on how big the stones were, and you have not

provided any information about that. If they were quite small (like grains of

sand), I suppose they could form quite quickly. Did your doctor give you any

indications of their size?

It's known that when starting on ursodiol for the first time " the proportion of

total biliary bile salts comprised by ursodiol increases within 1 to 2 weeks

from 1% to a maximum of approximately 60% " :

http://www.annals.org/cgi/content/full/121/3/207

So it is likely that doing the opposite (i.e. being taken off ursodiol) could

cause the percent ursodiol in the bile to decrease from 60% to 1% within 1 to 2

weeks.

Ursodiol is important for dissolving cholesterol gallstones because it is more

hydrophilic (water-loving) than the more hydrophobic (water-fearing) bile salts

often accumulated in the bile in cholestatic liver diseases. The cholesterol has

a harder time precipitating out of solution in a hydrophilic bile containing

ursodiol than in a hydrophobic bile that is deficient in ursodiol. Moreover the

cholesterol more readily dissolves in a hydrophilic bile containing ursodiol

than in a hydrophobic bile that is deficient in ursodiol.

As I mentioned earlier, biliary cholesterol supersaturation is the main problem

in gallstone and bile stone formation, and ursodiol therapy also inhibits

cholesterol synthesis in the liver, thereby lowering the cholesterol content of

the bile. The biliary concentration of cholesterol is probably not closely

related to your total serum cholesterol. Thus, biliary concentration of

cholesterol could possibly go up without this showing up in your total serum

cholesterol level during the short-term.

Best regards,

Dave

(father of (23)

>

> Dave,

> Hi!  Thanks for the explanation.  I wasn't actually taken off the Ursodiol

until about a week before they found the stones.  I'd been on high dose for

several years prior to that.  Would that lag time be enough time for the stones

to form or would they have had to have been there all along?  Any idea?  Also,

they say my cholesterol level is fine.  Is this a different type of cholesterol?

> Thanks!  

> Sandi

>

[Guest guest]

Dear Joe;

The data on ursodiol protecting against recurrent PSC after liver

transplantation is pretty sparse right now. Only one paper seems to indicate

that it " may " delay recurrence (i.e. slow progression of rPSC):

_______________________

Transpl. Int. 22: 144-152 (2009)

Autoimmune liver diseases and recurrence after orthotopic liver transplantation:

what have we learned so far?

Schreuder TC, Hübscher SG, Neuberger J

Liver Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.

t.schreuder@...

Primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC) and

autoimmune hepatitis (AIH) may all recur after liver transplant. Diagnosis of

rPBC is defined by histology; rAIH by serology, biochemistry and histology; rPSC

by histology and/or imaging of the biliary tree and exclusion of other causes of

nonanastomotic biliary strictures. Criteria for recurrent disease (RD) may

differ from those used in similar disease in the native liver: frequent use of

immunosuppressive therapy changes the pattern and natural history of RD and can

co-exist with other transplant-related causes of graft damage. RD may occur in

the presence of normal liver tests; the reported incidence will depend on the

way in which diagnostic tests (especially protocol biopsies) are applied. The

risk of RD increases with time, but does not correlate with the rate of graft

loss. Treatment is largely unproven: ursodeoxycholic acid will improve serology

and may slow progression of rPSC and rPBC; introduction or increased dose of

corticosteroids may reduce progression of rAIH. Risk factors for rPBC include

use of tacrolimus compared with cyclosporine; for rPSC include absence of colon

peri-transplantation and for rAIH possible associations with some HLA haplotypes

have been suggested.

PMID: 18662365.

_______________________

Since Mayo Clinic can't decide whether or not urso delays progression of PSC

before transplantation, despite 15 or so years of research, and is now taking

patients off urso because of some as yet unpublished adverse effects, we are

unlikely to see any significant research on urso and recurrent PSC in the U.S.A

in the future.

In Europe, however, the general consensus is that the benefits of ursodiol

(gallstone dissolution; improved liver biochemistry; protection against colon

cancer and possibly cholangiocarcinoma) far outweigh any risks.

I have read that gallstones can sometimes migrate from the gallbladder and block

the common bile duct, but I can't say for sure whether this could have happened

in your case, leading to your transplant. Sorry!

Best regards,

Dave

(father of (23); PSC 07/03; UC 08/03)

[Guest guest]

Dear Joe;

The data on ursodiol protecting against recurrent PSC after liver

transplantation is pretty sparse right now. Only one paper seems to indicate

that it " may " delay recurrence (i.e. slow progression of rPSC):

_______________________

Transpl. Int. 22: 144-152 (2009)

Autoimmune liver diseases and recurrence after orthotopic liver transplantation:

what have we learned so far?

Schreuder TC, Hübscher SG, Neuberger J

Liver Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.

t.schreuder@...

Primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC) and

autoimmune hepatitis (AIH) may all recur after liver transplant. Diagnosis of

rPBC is defined by histology; rAIH by serology, biochemistry and histology; rPSC

by histology and/or imaging of the biliary tree and exclusion of other causes of

nonanastomotic biliary strictures. Criteria for recurrent disease (RD) may

differ from those used in similar disease in the native liver: frequent use of

immunosuppressive therapy changes the pattern and natural history of RD and can

co-exist with other transplant-related causes of graft damage. RD may occur in

the presence of normal liver tests; the reported incidence will depend on the

way in which diagnostic tests (especially protocol biopsies) are applied. The

risk of RD increases with time, but does not correlate with the rate of graft

loss. Treatment is largely unproven: ursodeoxycholic acid will improve serology

and may slow progression of rPSC and rPBC; introduction or increased dose of

corticosteroids may reduce progression of rAIH. Risk factors for rPBC include

use of tacrolimus compared with cyclosporine; for rPSC include absence of colon

peri-transplantation and for rAIH possible associations with some HLA haplotypes

have been suggested.

PMID: 18662365.

_______________________

Since Mayo Clinic can't decide whether or not urso delays progression of PSC

before transplantation, despite 15 or so years of research, and is now taking

patients off urso because of some as yet unpublished adverse effects, we are

unlikely to see any significant research on urso and recurrent PSC in the U.S.A

in the future.

In Europe, however, the general consensus is that the benefits of ursodiol

(gallstone dissolution; improved liver biochemistry; protection against colon

cancer and possibly cholangiocarcinoma) far outweigh any risks.

I have read that gallstones can sometimes migrate from the gallbladder and block

the common bile duct, but I can't say for sure whether this could have happened

in your case, leading to your transplant. Sorry!

Best regards,

Dave

(father of (23); PSC 07/03; UC 08/03)

[Guest guest]

Dear Joe;

The data on ursodiol protecting against recurrent PSC after liver

transplantation is pretty sparse right now. Only one paper seems to indicate

that it " may " delay recurrence (i.e. slow progression of rPSC):

_______________________

Transpl. Int. 22: 144-152 (2009)

Autoimmune liver diseases and recurrence after orthotopic liver transplantation:

what have we learned so far?

Schreuder TC, Hübscher SG, Neuberger J

Liver Unit, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.

t.schreuder@...

Primary biliary cirrhosis (PBC), primary sclerosing cholangitis (PSC) and

autoimmune hepatitis (AIH) may all recur after liver transplant. Diagnosis of

rPBC is defined by histology; rAIH by serology, biochemistry and histology; rPSC

by histology and/or imaging of the biliary tree and exclusion of other causes of

nonanastomotic biliary strictures. Criteria for recurrent disease (RD) may

differ from those used in similar disease in the native liver: frequent use of

immunosuppressive therapy changes the pattern and natural history of RD and can

co-exist with other transplant-related causes of graft damage. RD may occur in

the presence of normal liver tests; the reported incidence will depend on the

way in which diagnostic tests (especially protocol biopsies) are applied. The

risk of RD increases with time, but does not correlate with the rate of graft

loss. Treatment is largely unproven: ursodeoxycholic acid will improve serology

and may slow progression of rPSC and rPBC; introduction or increased dose of

corticosteroids may reduce progression of rAIH. Risk factors for rPBC include

use of tacrolimus compared with cyclosporine; for rPSC include absence of colon

peri-transplantation and for rAIH possible associations with some HLA haplotypes

have been suggested.

PMID: 18662365.

_______________________

Since Mayo Clinic can't decide whether or not urso delays progression of PSC

before transplantation, despite 15 or so years of research, and is now taking

patients off urso because of some as yet unpublished adverse effects, we are

unlikely to see any significant research on urso and recurrent PSC in the U.S.A

in the future.

In Europe, however, the general consensus is that the benefits of ursodiol

(gallstone dissolution; improved liver biochemistry; protection against colon

cancer and possibly cholangiocarcinoma) far outweigh any risks.

I have read that gallstones can sometimes migrate from the gallbladder and block

the common bile duct, but I can't say for sure whether this could have happened

in your case, leading to your transplant. Sorry!

Best regards,

Dave

(father of (23); PSC 07/03; UC 08/03)

[Guest guest]

Hi Sandi;

No need to apologize; and it's not silly at all! Sounds as if the stones may be

quite large, and so this would make it less likely that they could have formed

during one week as a result of being taken off of urso ... perhaps your doctor

might be able to make a better estimate of approximate time taken to form stones

of that size?

Best regards,

Dave R.