GallstonesTake a Pill and Call Me in the Morning?
ABSTRACT & COMMENTARY
Synopsis: Oral bile salt therapy is ineffective in the treatment of gallstones in children except in terms of relieving symptoms while on therapy.
Source: Gamba PG, et al. Is there a place for the medical treatment of children with gallstones? J Pediatr Surg 1997;32:476-478.
Gamba and associates evaluated their experience with 15 patients with radiolucent gallstones who were treated with ursodeoxycholic/chenodeoxycholic acid. Both of these agents are bile acids that have been found to solubilize gallstones in some adult patients. Similar to adult studies, Gamba et al found that the bile acids were not particularly effective in dissolving gallstones. They disappeared in only two of 15 children. When the gallstones had dissolved with treatment, they quickly recurred when the bile salts were stopped. However, some of the symptoms associated with the gallstones improved while on bile acids.
COMMENT BY A. CRAIG HILLEMEIER, MD, FAAP
Gallstones in children are warning signs to initiate a search for other conditions such as hemolytic disease (reticulocyte count), structural anomalies in the biliary tree (ultrasound), or malabsorption secondary to ileal disease.
If these evaluations are negative, the child is most likely to have idiopathic gallstones that are thought to be secondary to abnormalities in cholesterol, lipid, or bile salt concentrations of the bile. The take-home message for the treatment of gallstones during childhood with exogenous bile acids is that, most of the time, they do not work.
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