1. Ursodeoxycholic acid in the treatment of intrahepatic cholestasis of pregnancy: a randomized controlled trial
Titta Joutsiniemi • Susanna Timonen • Riitta Leino • Pertti Palo • Ulla Ekblad. Arch Gynecol Obstet (2014) 289:541–547
The treatment of ICP has been mainly symptomatic. Phenobarbital, cholestyramine, S-adenosyl-L-methionine, dexamethasone and ursodeoxycholic acid (UDCA) have been used. Dexametasone has been shown to relieve pruritus and normalize serum levels of alanine amino-transferase (ALAT) and bile acids but to suppress fetoplacental estrogen production. Glantz et al. reported that dexametasone yielded no alleviation of pruritus or reduction of ALAT and was less effective than UDCA at reducing bile acid concentration. Rongaclia et al. showed that UDCA was also more effective than S-adenosyl-L-methionine at improving the liver tests, although both therapies were equally effective at improving pruritus. In the pilot study by Palma et al. UDCA amelioriated pruritus and lowered liver enzyme concentrations in patients with ICP. In the study of Nicastri et al. women taking UDCA had signiﬁcantly greater decreases in liver function tests than women taking placebo. UDCA has a role in improving clinical and biochemical results in ICP also in the study of Diaferia et al.. In the latest randomized trial by Chappell et al. UDCA signiﬁcantly reduces pruritus, but the size of the effect was small.
2. Effect of Colitis and Ileoanal Pouch on Biliary Enrichment of Ursodeoxycholic Acid in Primary Sclerosing Cholangitis
D. ROST, G. RUDOLPH, P. KLOETERS-PLACHKY and A. STIEHL. Digestive Diseases and Sciences, Vol. 51, No. 3 (March 2006), pp. 618–622
In patients with colectomy and pouch, the secondary bile acids deoxycholic acid and lithocholic acid were markedly reduced. Under physiologic conditions these bile acids are formed by anaerobic bacteria in the colon, and therefore their decrease was as expected. In the colon, UDCA is bacterially degraded to 7 keto-lithocholic acid and lithocholic acid; 7 keto-lithocholc acid may be passively absorbed and transformed in the liver to chenodeoxycholic acid and ursodeoxycholic acid. Surprisingly, the absence of colonic bacterial degradation of UDCA, however, had no signiﬁcant effect on its own biliary enrichment and also no effect on the biliary content of chenodeoxycholic acid.
3. Ursodeoxycholic Acid Treatment in Abdominal Sarcoidosis
LUIGI BARATTA, ANTONIA CASCINO. Digestive Diseases and Sciences, Vol. 45, No. 8 (August 2000), pp. 1559–1562
UDCA has well-known hepatoprotective properties. Long-term administration of UDCA results in the elevation of bile concentrations, thus reducing the amount of endogenous hydrophobic acids (chenodeoxycholic, deoxycholic), which are hepatotoxic and destabilize the cell membrane. UDCA also seems to have an immunomodulating property. It reduces the expression of class I HLA antigen on the cell membrane of hepatocytes and class II HLA antigen on the cell membrane of the biliar duct epithelial cells: both antigens are considered as targets of T cytotoxic lymphocytes during cholestasis. UDCA showed a transitory beneﬁcial effect in patients with PBC and granulomatous hepatitis, improving biochemical and clinical indices, even without any major histological changes.