Ursodeoxycholic Acid (UDCA) in Symptomatic Patients with Uncomplicated Cholelithiasis Unfit for or Refusing Surgery: A Narrative Review

Background. Cholelithiasis is one of the most prevalent gastrointestinal disorders worldwide, affecting approximately 10–20% of the adult population in developed countries. Although laparoscopic cholecystectomy remains the gold standard treatment for symptomatic gallstones, a significant subset of patients is either unsuitable for surgery due to comorbidities, advanced age, anesthesia-related risks, or declines operative management. In such cases, ursodeoxycholic acid (UDCA) has been proposed as a non-invasive therapeutic alternative. Aim. This narrative review aims to critically evaluate the current evidence regarding the mechanisms, indications, efficacy, and limitations of UDCA therapy in symptomatic patients with uncomplicated gallstone disease who are not undergoing surgical intervention. Material and Methods. A narrative review was conducted by integrating data from clinical guidelines, randomized controlled trials, cohort studies, and systematic reviews. Particular emphasis was placed on outcomes such as symptom control, gallstone dissolution, recurrence rates, and patient selection criteria. Results. UDCA demonstrate beneficial effects in carefully selected patient populations, particularly in terms of gallstone dissolution and symptom relief. However, its clinical utility is limited by strict eligibility criteria, a slow therapeutic response, and high recurrence rates following treatment discontinuation. Conclusion. UDCA may represent a valuable non-surgical treatment option in selected high-risk patients when individualized appropriately. Nevertheless, its overall effectiveness remains limited, and careful patient selection is essential to optimize therapeutic outcomes.