Ursodeoxycholic acid (UDCA) is a bile acid produced naturally in the liver. Its chemical name is 3α, 7β-dihydroxy-5β-cholanoic acid. UDCA is one of the primary bile acids found in bears, which gave rise to its name - "ursodeoxycholic acid". In humans, UDCA accounts for only about 5-10% of the total bile acids synthesized by the liver.
Mechanism of Action
UDCA works by replacing more toxic bile acids in the liver and bile. The liver produces different kinds of bile acids to help in the digestion of fats. Some of these naturally produced bile acids like chenodeoxycholic acid can become toxic to liver cells in high amounts. UDCA acts to replace these potentially toxic bile acids and helps protect the liver cells from damage. UDCA is also thought to have anti-inflammatory and immune modulating properties that help reduce liver inflammation.
Uses of UDCA in Liver Diseases
UDCA is currently approved as a treatment for several chronic liver diseases like:
Primary Biliary Cholangitis (PBC):
PBC is an autoimmune disease where the bile ducts in the liver are slowly destroyed over time. This leads to a buildup of bile and liver damage. UDCA helps stimulate bile flow and has anti-inflammatory effects that can slow disease progression in PBC patients. Studies have shown that 13-17% of PBC patients on UDCA do not require a liver transplant over 7-10 years compared to untreated patients.
Gallstone Dissolution:
UDCA is also useful in dissolving gallstones. Gallstones are hardened deposits of cholesterol or bilirubin that form inside the gallbladder. UDCA acts by reducing the saturation of cholesterol in bile which allows gallstones to dissolve over time in many cases. A 6-12 month course of UDCA can successfully dissolve gallstones in nearly 80% of selected patients.
Prevention of Stone Recurrence:
Ursodeoxycholic Acid is given long term to patients who have already undergone gallstone removal surgery as it can prevent new gallstones from forming again by altering the composition of bile secreted by the liver.
Primary Sclerosing Cholangitis (PSC):
PSC is a chronic disease characterized by inflammation and scarring of the bile ducts. While UDCA does not show significant benefit in reversing PSC, it helps reduce symptoms and biochemical markers of cholestasis when taken for at least 1 year. This suggests it plays some role in managing the disease long term.
Non-Alcoholic Fatty Liver Disease (NAFLD):
UDCA improves liver tests and histology in patients with NAFLD and may reduce the risk of progression to non-alcoholic steatohepatitis (NASH) according to some recent research. Larger studies are still ongoing to define its role in treatment of NAFLD.
Does UDCA have any side effects?
In general, UDCA is well tolerated and side effects are usually mild. Some common side effects experienced by less than 10% of patients include nausea, abdominal discomfort, loose stools and increased sweating. Rare but potentially serious side effects like severe allergic reactions and abnormal breakdown of fats in the blood have also been reported. Long term use of UDCA should be done only under medical supervision and monitoring of liver tests. Pregnant or breastfeeding women should consult their doctor before use.
Role of Ursodeoxycholic Acid in Future
While UDCA is currently used for a few chronic liver conditions, ongoing research is exploring its potential in other areas:
- NASH with advanced fibrosis: Studies evaluating whether UDCA can prevent progression to cirrhosis in NASH patients are in progress.
- Alcoholic Liver Disease: Early results suggest UDCA improves liver inflammation and function in alcoholic hepatitis. Larger trials are evaluating the optimal dose and duration of treatment.
- Viral Hepatitis: Preliminary research indicates UDCA may reduce progression of fibrosis in chronic hepatitis B and C patients when combined with antiviral therapy.
- Drug-Induced Liver Injury: UDCA appears to promote liver regeneration and recovery in cases of liver damage caused by certain drugs and herbal supplements.
as a natural bile acid produced by the liver, Ursodeoxycholic Acid has a unique mechanism of protecting liver cells from damage through its cytoprotective properties. Further clinical evidence may expand UDCA's role as an adjuvant or even primary treatment for additional liver conditions in the future.
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