ACE+TUDCA Therapy Effective for Reducing Clinical Symptoms of Gallstones

Gallstones. Illustration showing the liver and gallbladder with gallstones. The gallbladder stores bile, the digestive fluid that is produced by the liver (above gallbladder) and passed to the small intestine. Gallstones, hard deposits formed of cholesterol and bile salts, form in the gallbladder when there is an imbalance in the chemical composition of the bile. Gallstones are usually symptomless, unless one obstructs the bile duct, causing acute pain, jaundice and infection. Treatment is with drugs to dissolve the stones or surgical removal of the gallbladder.
Investigators assessed the effects of treatment with acupoint catgut embedding plus tauroursodeoxycholic acid on symptom improvement in patients with gallstones.

Acupoint catgut embedding (ACE) plus tauroursodeoxycholic acid (TUDCA) therapy for 8 weeks can significantly improve gallbladder emptying and reduce clinical symptoms in patients with gallstones, according to a study in the Journal of Clinical Gastroenterology.

The prospective, randomized, clinical study enrolled 70 patients with gallstones from August 2018 to January 2019 at a university hospital in China. Participants were randomly assigned to the ACE group (ACE+TUDCA treatment for 8 weeks) or the sham group (sham ACE+TUDCA treatment for 8 weeks). All participants were asked to take TUDCA 500 mg daily at bedtime and were treated with ACE or sham ACE every 2 weeks for 4 sessions. Ultrasound was used to assess gallbladder emptying.

The following clinical symptoms were assessed: middle and right upper abdominal pain (symptom 1), bitter taste (symptom 2), gallbladder tenderness (symptom 3), back pain (symptom 4), fullness in the upper abdomen (symptom 5), fecal characteristics (symptom 6), and nausea and vomiting (symptom 7).

The final analysis included 63 patients (mean age, 43.6±14.5 years; 34.9% men). Of the cohort, 33 participants received ACE+TUDCA (ACE group), and 30 participants received sham ACE +TUDCA (sham group). ACE group participants were aged mean 40.6±13.9 years, and 10 (30.3%) were men. Sham group participants were aged mean 47.3±14.4 years, and 12 (40.0%) were men.

Findings from the within-group analyses showed that gallbladder ejection fraction (GBEF) in the ACE group was significantly increased after 8-week ACE+TUDCA therapy. All 7 symptom scores except for nausea and vomiting were reduced significantly, and total scores decreased from 6.1±3.7 to 2.3±2.2. In the sham group, no significant difference was found in GBEF after treatment, and only symptom 1, 2, 4, and 5 scores and total score were significantly decreased after sham ACE+TUDCA therapy.

Regarding results from between-groups analyses after 8 weeks, residual volume in the ACE group (11.1±6.2 mL) was significantly lower vs that in the sham group (23.4±11.5 mL), and empty volume and GBEF in the ACE group (8.7±7.8 mL and 41.0±18.5%, respectively) were significantly higher compared with the sham group (4.6±8.6 mL and 27.5±19.6%, respectively). The fecal characteristics score in the ACE group was significantly lower than that in the sham group after treatment, and no significant differences were found for all other symptom scores between the 2 groups.

Study limitations include the limited number of cases and lack of serological indexes.

“The present study shows that ACE protects [against] the effect of gallstones,” stated the investigators. “[L]arge-scale and multicenter studies with a longer follow-up time are still needed in the future to clarify these problems, and animal studies are also needed to verify the underlying mechanisms.”

Reference

Duan J, Chen X, Wang Y, et al. Acupoint catgut embedding as adjunctive therapy for patients with gallstones. J Clin Gastroenterol. 2022;56(1):e77-e83. doi: 10.1097/MCG.0000000000001487