Is ursodeoxycholic acid detrimental in obstructive cholestasis?: apropos a case of malignant biliary obstruction

BESSONE F.; ROMA M.G.

ANNALS OF HEPATOLOGY

MEXICAN ASSOC HEPATOLOGY

Año: 2016 vol. 15 p. 442 - 447

1665-2681

Ursodeoxycholic acid (UDCA) is the ?first choice?medication for most cholestatic hepatopathies, due to its capability tocounteract inflammation and bile-acid-induced liver damage, two common featuresin cholestasis. However, UDCA is usually contraindicated in obstructivecholestasis, due to the alleged risk of biliary integrity disruption due to itscholeretic effect. We report on an 83-year-old man with an unsuspectedmalignant biliary obstruction who received moderate doses of UDCA (8-12 mg/kg/day)for 5 weeks, because the preliminary evidence suggested he hadchemotherapy-induced cholestasis. Liver integrity was extensively protected byUDCA, as indicated by a marked decrease in serum liver enzymes, despite asteady increase in the levels of bilirubin and serum bile acids due to theobstructive process. In conclusion, this report shows, for the first time inhumans, that moderate UDCA doses can reduce liver injury associated with completebiliary obstruction. This may contribute to a better understanding of therisk-benefit ratio of the use of UDCA in obstructive cholangiopathies.