The Therapeutic Role of Ursodeoxycholic Acid in Digestive Diseases

Introduction

Ursodeoxycholic acid (UDCA) constitutes around 3% of the total bile acid pool in humans. Bacteria modify another naturally occurring bile acid, chenodeoxycholic acid, in the gut to form UDCA. The UDCA is a primary bile acid found in bears, and it was discovered in polar bears by Swedish and Danish explorers in Greenland in the early 1900s. Later UDCA was isolated from the black bear and given its current name for being an isomer of deoxycholic acid.

Abstract

Ursodeoxycholic acid (UDCA) makes up a small portion of the naturally occurring bile acid pool in humans, and the drug is effective in several diseases. The mechanism of action involves the displacement of more toxic endogenous bile acids, direct protection of hepatocytes against apoptosis, and stimulation of endogenous secretion of bile to alleviate cholestasis. The use of UDCA has been studied extensively in primary biliary cirrhosis and cholelithiasis and there is evidence for its use in both diseases. There is also evidence against the use of UDCA in primary sclerosing cholangitis (PSC). Several potential uses of UDCA warrant further investigation after initial studies have shown promise including treatment for microlithiasis, intrahepatic cholestasis of pregnancy, total parenteral nutrition, chemoprophylaxis of colorectal cancer in patients with ulcerative colitis and PSC, viral hepatitis, and in bone marrow transplantation. Ursodeoxycholic acid is generally well tolerated with few adverse events, though minor weight gain is a common side effect.

Keywords

Ursodeoxycholic acid, primary biliary cirrhosis, primary sclerosing cholangitis, cholelithiasis, microlithiasis