Table 2: Current status on preventive approaches to
cholesterol GSD.
Condition |
Approach |
Expected
outcome (s) |
Notes |
PRIMARY
PREVENTION |
|
|
|
General
population |
Healthy lifestyles Maintainance of ideal body weight Weight decrease and maintainance Regular physical activity Healthy diet Vitamin C consumption |
Prevention,
cure of concomitant metabolic disturbances |
e.g.
dyslipidemia, overweight, obesity, insulin resistance, diabetes, etc. |
Obese
patients on rapid weight loss -
very low calorie diets -
bariatric surgery |
Weight loss of less than 1.5 Kg/week |
Decreased
biliary saturation with cholesterol Decreased
propensity to cholesterol crystallization |
Consider
close clinical follow-up |
|
Increased amount of dietary fat (at least 7g/day) |
Improved
gallbladder motility |
Controversial
effect |
|
Oral UDCA (300-1, 200 mg/day) |
Decreased
biliary saturation with cholesterol Decreased
propensity to cholesterol crystallization |
Limited
period (decreased risk after body weight stabilization) |
|
Fish oil supplementation |
Experimental
and preliminary data Increased
biliary phospholipids (?) Effect
on intrahepatic cholesterol transport (?) |
In
particular during very low calorie diets. No effect on cholesterol saturation
index [48]. |
|
Aspirin |
Anti
inflammatory effect |
No
indication |
|
Prophylactic cholecystectomy (during
Roux-en-Y gastric bypass) |
|
Not
routinely indicated |
Patients on long-term therapy with
somatostatin or analogues |
Oral UDCA (300-1, 200 mg/day) |
Decreased
biliary saturation with cholesterol Decreased
propensity to cholesterol crystallization |
Few
prospective studies |
Patients
with marked transient gallbladder stasis |
No indication for medical therapy |
Spontaneous
disappearance of sludge/small gallstones after restoration of physiological
condition |
Consider
clinical follow-up |
-
Total parenteral nutrition |
Oral UDCA (300-1, 200 mg/day) |
Decreased
biliary saturation with cholesterol Decreased
propensity to cholesterol crystallization |
Controversial
indication (spontaneous disappearance of gallstone/sludge after restoration
of oral diet). Consider
clinical follow up |
-
Pregnancy |
Healthy lifestyles Maintainance of nutritional
requirement |
Sludge,
microstones can be transient |
Spontaneous
disappearance of gallstone/sludge in the postpartum period. Consider
clinical follow up |
Patients
on hormone therapy |
No indication |
Lack
of controlled trials |
Physicians who prescribe hormone replacement
therapy should be aware of the increased risk for gallstones. Currently there
is no indication for pharmacological or surgical stone prevention during
hormone replacement therapy |
SECONDARY
PREVENTION |
|
|
|
-
Risk of recurrent gallstones |
Oral UDCA (300-1, 200 mg/day) |
Limitations: overall costs of chronic
treatment and poor compliance. Advisable only in high risk subgroups (not
fitting the criteria for subsequent cholecystectomy) |
No
specific recommendation can be given for the pharmacological prevention of
recurrent gallstones |
-
Risk of recurrent bile duct stones |
No indication |
|
No
specific recommendation can be given for the pharmacological prevention of
recurrent gallstones |
-
Risk of recurrent gallstones, intrahepatic sludge and microlithiasis (low
phospholipid-associated cholelithiasis) |
Oral UDCA (300-1, 200 mg/day) |
|
Prophylactic
long term therapy with UDCA to be initiated as early as possible. |
Abbreviations: GSD: gallstone disease, UDCA:
ursodeoxycholic acid