The aim of this study is the evaluation of the effect of UDCA in liver functional restoration of patients with obstructive jaundice in the early period after endoscopic intervention. Specific aims consisted on the evaluation of the effect of UDCA in relation to etiology of obstructive jaundice, to gender, and to age of patients. The most common causes of obstructive jaundice are choledocholithiasis, strictures of the biliary tract, cholangiocarcinoma, carcinoma of pancreas, pancreatitis, parasites and primary sclerosing cholangitis. When mechanical biliary obstruction is diagnosed, surgical, endoscopic or radiologic intervention is usually recommended.
In this prospective, randomized, open-labeled, and controlled study, 62 patients were enrolled. After diagnosis, eligible patients with obstructive jaundice who met inclusion criteria were randomly divided in the investigation group, in which has been administered UDCA, and in the control group. UDCA administration started twenty-four hours after endoscopic treatment. It was administered at 750 mg/day, divided into three daily doses and lasted fourteen days. Serum-testing in patients with obstructive jaundice included determination of bilirubin (total and direct fractions), alanine transaminase (ALT), aspartate transaminase (AST), gama-glutamil transpeptidase (GGT), alkaline phosphatase (ALP), albumin, neutrophil/ lymphocyte ratio (N/L ratio), urea, glucose, and creatinine. These parameters were determined one day prior endoscopic intervention, and on the fifth, tenth, and fifteenth days after endoscopic intervention. The primary outcome measure in this study was bilirubin, alkaline phosphatase, and GGT serum levels decreasing rate. The secondary outcome was assessment liver functional parameters in which, treatment with UDCA, have had greater impact.
UDCA has accelerated reducing the level of total bilirubin, direct bilirubin, GGT, and neutrophil/lymphocyte ratio, but did not decrease the level of ALT, AST, and alkaline phosphatase, and did not induce increasing of albumin level. UDCA had greater impact on GGT than in other functional liver parameters. The effect of UDCA did not depend on the gender and the age of patients, but did depend on the etiology of obstructive jaundice. It was more effective in patients with choledocholithiasis than in patients with malign stenosis of biliary tree.
Table of Contents
1 BACKGROUND
1.1 Epidemiology
1.2 The diagnosis of obstructive jaundice
1.2.1 The clinical presentation
1.2.2 Laboratory findings
1.2.3 Imaging examination
1.2.3.1 Transabdominal sonography
1.2.3.2 Endoscopic sonography
1.2.3.3 Computed tomography
1.2.3.4 Magnetic Resonance Cholangiography (MRCP)
1.2.3.5 Endoscopic Retrograde Cholangiopancreatography (ERCP)
1.2.3.6 Percutaneous Transhepatic Cholangiopancreatography (PTC)
1.3 Differential diagnosis of jaundice
1.4 Obstructive jaundice- related complications
1.4.1 Intestinal permeability in obstructive jaundice
1.4.2 Hemostasis impairment in patients with obstructive jaundice
1.4.3 Obstructive jaundice and renal dysfunction
1.4.4 Obstructive jaundice and hepatic dysfunction
1.5 Treatment modalities
1.5.1 Endoscopic Retrograde Cholangiopancreatography (ERCP)
1.5.2 Surgical treatment
1.6 Ursodeoxycholic acid and its properties
1.6.1 Mechanisms of action of UDCA
1.6.1.1 Protection by UDCA against cell death induced by cytotoxic bile acids
1.6.1.2 Modulation of the expression of liver transporters and enzyme systems by UDCA
1.6.1.3 Modulation of cholangiocyte transport and ductular bile flow by UDCA
1.6.1.4 Immunosuppressive and anti-inflammatory properties of UDCA
2 AIMS AND PURPOSE OF THE RESEARCH
2.1 General aim
2.2 Specific aims
3 METHODS/DESIGN
3.1 Study objectives
3.2 Study design
3.2.1 ERCP procedure
3.2.2 Biochemical testing
3.2.3 Inclusion criteria
3.2.4 Exclusion criteria
3.2.5 UDCA administration
3.2.6 Power of the study
3.2.7 Data sources and search strategy
3.2.8 Outcomes
3.2.9 Randomization
3.2.10 Ethics
3.2.11 Data collection and statistical analysis
4 RESULTS
4.1 The effect of UDCA in relation to gender of patients
4.2 The effect of UDCA in relation to etiology of obstructive jaundice
4.3 The effect of UDCA in relation to age of patients
5 DISCUSSION
6 CONCLUSIONS
Research Objectives and Themes
This study aims to evaluate the efficacy of Ursodeoxycholic acid (UDCA) in restoring liver function in patients suffering from obstructive jaundice following endoscopic intervention. The research investigates how UDCA treatment impacts various biochemical markers across different patient demographics and etiologies.
- Liver functional restoration post-endoscopic treatment
- Clinical evaluation of UDCA administration
- Comparative analysis of obstructive jaundice etiologies
- Impact of gender and age on UDCA treatment response
- Biochemical marker trends including bilirubin, ALT, AST, GGT, and ALP
Excerpt from the Book
1.6 Ursodeoxycholic acid and its properties
From the chemical structural point of view, ursodeoxycholic acid (UDCA) is 3α, 7β- dihydroxy- 5β- cholanoic acid, a bile acid with two hydroxy groups(OH¯) at positions 3 and 7 in the cholane ring structure, with α and β- orientation respectively [51, 52]. UDCA is a tertiary bile acid which is more and more frequently used in the treatment of different cholestatic diseases. It is normally present in humane bile, but in a low concentration of only 3% of total bile acids. UDCA is the major component of bile acids in black bear bile [53].
UDCA has been used as part of a traditional Chinese medicine from the time of the Tang Dynasty (618-907 AD) for the treatment of jaundice, which employed the bile of black bears to cure several liver diseases. Its therapeutic use was rediscovered many years later by modern medicine, with the first reports on its use in Japan in 1961, followed by the publication of the first controlled trial in patients with primary biliary cirrhosis in 1989 [54].
Summary of Chapters
1 BACKGROUND: Provides an overview of obstructive jaundice, its causes, complications, and the therapeutic potential of Ursodeoxycholic acid.
2 AIMS AND PURPOSE OF THE RESEARCH: Outlines the primary goal of assessing liver function recovery using UDCA and specifies short-term evaluation objectives.
3 METHODS/DESIGN: Details the prospective, randomized, controlled study methodology, including patient selection, ERCP procedure, and statistical analysis techniques.
4 RESULTS: Presents comprehensive data on biochemical changes in patients treated with UDCA, categorized by gender, etiology, and age.
5 DISCUSSION: Interprets the study findings, compares them with existing medical literature, and reflects on the clinical implications of UDCA therapy.
6 CONCLUSIONS: Summarizes the key findings, noting UDCA’s efficacy in accelerating the reduction of certain bilirubin and enzyme levels while highlighting variations based on jaundice etiology.
Keywords
obstructive jaundice, ursodeoxycholic acid, UDCA, endoscopic retrograde cholangiopancreatography, ERCP, liver function, bilirubin, alkaline phosphatase, GGT, ALT, AST, cholestasis, biliary obstruction, medical treatment
Frequently Asked Questions
What is the primary focus of this research?
The research focuses on evaluating the influence of Ursodeoxycholic acid (UDCA) on the recovery of liver function in patients who have undergone endoscopic treatment for obstructive jaundice.
What are the core research themes?
The core themes include the biochemical monitoring of patients with obstructive jaundice, the therapeutic role of UDCA, and how factors like age, gender, and the specific cause of the obstruction influence recovery.
What is the primary research question?
The research asks whether the administration of UDCA in the early post-endoscopic period significantly improves the rate of liver functional recovery compared to patients who do not receive the acid.
Which scientific method was applied?
The study employed a prospective, randomized, open-labeled, and controlled clinical trial design, involving 62 patients divided into an investigation group (UDCA) and a control group.
What topics are covered in the main body?
The main body covers the theoretical background of biliary obstruction, comprehensive diagnostic methodologies (ERCP, MRCP, CT), mechanisms of UDCA, detailed study design, and extensive data analysis of liver enzyme and bilirubin levels.
Which keywords best describe the study?
Key terms include obstructive jaundice, UDCA, ERCP, liver function, bilirubin, alkaline phosphatase, and cholestasis.
Does UDCA affect all patients equally regardless of the cause of jaundice?
No, the study concludes that UDCA is more effective in patients with choledocholithiasis than in those with malignant stenosis of the biliary tree.
Did patient age have a significant impact on the effectiveness of UDCA?
The study found that patient age had no significant impact on the overall effect of UDCA and did not modulate its performance.
- Quote paper
- Enver Fekaj (Author), 2019, The Influence of Ursodeoxycholic Acid in Liver Functional Restoration in Obstructive Jaundice after Endoscopic Treatment, Munich, GRIN Verlag, https://www.grin.com/document/505328
