LETTER
Prevention of Gallstones during Weight Reduction
Todd Kaye, MD
1 March 1996 | Volume 124 Issue 5 | Pages 532-533
TO THE EDITOR:
Shiffman and colleagues [1] have shown that ursodeoxycholic acid (UDCA) is effective in preventing gallstone formation in patients receiving a very-low-calorie diet. The reported incidence of gallstone formation in patients receiving placebo (28%) is similar to that noted in other reports [2]. However, most gallstones that form while patients are receiving a very-low-calorie diet are asymptomatic. The highest reported incidence of symptomatic gallstones causing cholecystitis is 6% [2], and the largest study that reported such data [3] showed only one case of symptomatic gallstones among 517 patients receiving a very-low-calorie diet and only one other case requiring a cholecystectomy in the year after treatment. Other series have reported an incidence of cholecystitis ranging from 0% to 3% [4]. In my experience with more than 75 patients receiving a very-low-calorie diet, I have seen no episodes of symptomatic gallstones. Asymptomatic gallstones that form while patients are receiving a very-low-calorie diet may spontaneously resolve [2].
Given the low incidence of symptomatic gallstones in patients receiving a very-low-calorie diet, giving UDCA to all patients would only add cost to an already expensive treatment. I doubt that the prophylactic use of UDCA in such patients will reduce the health care costs associated with the treatment of symptomatic gallstones.
Todd Kaye, MD
Lahey Clinic
Burlington, MA 01805
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Author and Article Information
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Lahey Clinic Burlington, MA 01805
1. Shiffman ML, Kaplan GD, Brinkman-Kaplan V, Vickers FF. Prophylaxis against gallstone formation with ursodeoxycholic acid in patients participating in a very-low-calorie diet program. Ann Intern Med. 1995; 122:899-905.
2. Liddle RA, Goldstein RB, Saxton J. Gallstone formation during weight-reduction dieting. Arch Intern Med. 1989; 149:1750-3.
3. Wadden TA, Foster GD, Letizia KA, Stunkard AJ. A multicenter evaluation of proprietary weight reduction program for the treatment of marked obesity. Arch Intern Med. 1992; 152:961-6.
4. Anderson JW, Hamilton CC, Brinkman-Kaplan V. Benefits and risks of an intensive very-low-calorie diet program for severe obesity. Am J Gastroenterol. 1992; 87:6-15.
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