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Refractory functional dyspepsia (RFD) is diagnosed when symptoms persist for at least 6 months despite at least two medical treatments. No consensus treatment guidelines exist. The implicated causes of functional biliary dyspepsia are a narrowed cystic duct, Sphincter of Oddi dysfunction, microlithiasis, and gallbladder dyskinesia. We investigated the treatment effects of litholytic agents. RFD patients were prospectively enrolled in six tertiary medical centers. All subjects took chenodeoxycholic and ursodeoxycholic acids (CNU) twice daily for 12 weeks. We monitored their medication adherence, laboratory results, and complications. The 7-point global symptom scale test scores were determined before and after treatment. Of the 52 patients who were prospectively screened, 37 were included in the final analysis. The mean age was 51.3 years: 14 were males, and 23 were females. Before treatment, the mean number and duration of symptoms were 2.4 and 48.2 months, and a mean of 3.3 FD-related drugs were taken. The mean CNU adherence was 95.3%. The mean global symptom scale score decreased from 5.6 pretreatment to 2.6 posttreatment. The symptom improvement rate was 94.6% (35 out of 37 patients). The only adverse event was mild diarrhea (10.8%) that was resolved after conservative management. Conclusions: CNU improved the symptoms of RFD patients who did not respond to conventional medications. Litholytic agents are good treatment options for patients with RFD and biliary dyspepsia secondary to biliary microlithiasis. Further prospective, large-scale mechanistic studies are warranted. [ABSTRACT FROM AUTHOR]

Refractory functional dyspepsia (RFD) is diagnosed when symptoms persist for at least 6 months despite at least two medical treatments. No consensus treatment guidelines exist. The implicated causes of functional biliary dyspepsia are a narrowed cystic duct, Sphincter of Oddi dysfunction, microlithiasis, and gallbladder dyskinesia. We investigated the treatment effects of litholytic agents. RFD patients were prospectively enrolled in six tertiary medical centers. All subjects took chenodeoxycholic and ursodeoxycholic acids (CNU) twice daily for 12 weeks. We monitored their medication adherence, laboratory results, and complications. The 7-point global symptom scale test scores were determined before and after treatment. Of the 52 patients who were prospectively screened, 37 were included in the final analysis. The mean age was 51.3 years: 14 were males, and 23 were females. Before treatment, the mean number and duration of symptoms were 2.4 and 48.2 months, and a mean of 3.3 FD-related drugs were taken. The mean CNU adherence was 95.3%. The mean global symptom scale score decreased from 5.6 pretreatment to 2.6 posttreatment. The symptom improvement rate was 94.6% (35 out of 37 patients). The only adverse event was mild diarrhea (10.8%) that was resolved after conservative management. Conclusions: CNU improved the symptoms of RFD patients who did not respond to conventional medications. Litholytic agents are good treatment options for patients with RFD and biliary dyspepsia secondary to biliary microlithiasis. Further prospective, large-scale mechanistic studies are warranted.

In the process of biocrystallization and biomineralization, the growth of crystals occurs under tissue conditions prevalent in the body. Many biomaterial crystals are initiated at micrometre size and have different morphologies. Such micro-crystals play a pathogenetic role in different diseases. Hence, an in vitro method to induce micro-crystals of biomaterials is desirable as a model to study the morphogenesis as well as its reversal by intervention. A modified gel technique for the growth of micro-crystals of biomaterials is proposed. The growth of urinary type-calcium hydrogen phosphate dihydrate (CHPD) is carried out to verify the utility of the technique. Growth inhibition and dissolution of CHPD crystals by solutions of different concentrations of citric acid is studied in situ. This technique is economical, needs less amount of material and can be used in batches in aseptic conditions with in situ observations under optical microscope. For in vitro studies of growth inhibition and dissolution of biomaterial crystals by different solutions and herbal ayurvedic plant under aseptic conditions, the present model provides a screening tool for drug development of urinary litholytic agents. In the process of biocrystallization and biomineralization, the growth of crystals occurs under tissue conditions prevalent in the body. Many biomaterial crystals are initiated at micrometre size and have different morphologies. Such micro-crystals play a pathogenetic role in different diseases. Hence, an in vitro method to induce micro-crystals of biomaterials is desirable as a model to study the morphogenesis as well as its reversal by intervention. A modified gel technique for the growth of micro-crystals of biomaterials is proposed. The growth of urinary type-calcium hydrogen phosphate dihydrate (CHPD) is carried out to verify the utility of the technique. Growth inhibition and dissolution of CHPD crystals by solutions of different concentrations of citric acid is studied in situ. This technique is economical, needs less amount of material and can be used in batches in aseptic conditions with in situ observations under optical microscope. For in vitro studies of growth inhibition and dissolution of biomaterial crystals by different solutions and herbal ayurvedic plant under aseptic conditions, the present model provides a screening tool for drug development of urinary litholytic agents. [ABSTRACT FROM AUTHOR]

Background/Aims Biliary dyspepsia presents as biliary colic in the absence of explanatory structural abnormalities. Causes include gallbladder dyskinesia, sphincter of Oddi dysfunction, biliary tract sensitivity, microscopic sludges, and duodenal hypersensitivity. However, no consensus treatment guideline exists for biliary dyspepsia. We investigated the effects of medical treatments on biliary dyspepsia. Methods We retrospectively reviewed the electronic medical records of 414 patients who had biliary pain and underwent cholescintigraphy from 2008 to 2018. We enrolled patients who received litholytic agents and underwent follow-up scans after medical treatment. We divided the patients into the GD group (biliary dyspepsia with reduced gallbladder ejection fraction [GBEF]) and the NGD group (biliary dyspepsia with normal GBEF). We compared pre- and post-treatment GBEF and symptoms. Results Of the 57 patients enrolled, 40 patients (70.2%) had significant GBEF improvement post-treatment, ranging from 34.4%±22.6% to 53.8%±26.8% (p<0.001). Fifty-two patients (91.2%) experienced significant symptom improvement (p<0.001). In the GD group (n=35), the GBEF improved significantly in 28 (80.0%) patients (range, 19.5%±11.0% to 47.9%±27.3%; p<0.001). In the NGD group (n=22), the GBEF improved in 12 (54.5%) patients, which was not significant (p=0.401). Most patients (97.1% in the GD group and 81.8% in the NGD group) had improved symptoms (p<0.001). No severe complication was reported during the treatment period. Conclusions Litholytic agents improved biliary colic in patients with biliary dyspepsia. Therefore, these agents present an alternative treatment modality for biliary dyspepsia with or without gallbladder dyskinesia. Notably, biliary colic in patients with gallbladder dyskinesia resolved after normalization of the GBEF. Further prospective and large-scale mechanistic studies are warranted. [ABSTRACT FROM AUTHOR]