Synopsis

Source of validity: Scientific
Rating (out of 5): 4

Bile salts—especially in the form of ursodeoxycholic acid (UDCA)—are scientifically validated for supporting/treating certain types of gallstones, specifically cholesterol gallstones. Gallstones form when substances in bile, such as cholesterol, crystallize and aggregate. UDCA, a naturally occurring bile acid, works by reducing cholesterol saturation in bile, thereby dissolving cholesterol-rich gallstones over time. Numerous randomized controlled trials and meta-analyses have demonstrated UDCA’s effectiveness in dissolving small, radiolucent (non-calcified) cholesterol stones in patients with a functioning gallbladder. Treatment generally takes months to years, and the recurrence rate after cessation is significant, but it remains a non-surgical option for select patients who are poor surgical candidates or prefer to avoid surgery.

However, bile salts are not effective against pigment stones or calcified stones, and their use is generally not recommended in patients with symptomatic gallstones who are good surgical candidates. The evidence for other types of bile salts (such as chenodeoxycholic acid) is less robust due to higher side effect profiles. UDCA is included in clinical guidelines globally (such as those from the American Gastroenterological Association and European Association for the Study of the Liver) for specific scenarios. There is little traditional use of bile salts for gallstone treatment; their use is based on well-established biochemical and clinical research from the late 20th century onward.

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