Ursodeoxycholic Acid (UDCA) in Liver Diseases

Established Indications for UDCA

The American Association for the Study of Liver Diseases recommends UDCA as a primary treatment for primary biliary cirrhosis (PBC) at doses of 13-15 mg/kg/day, where it significantly decreases serum bilirubin, alkaline phosphatase, and other liver enzymes 1
Long-term UDCA treatment delays histological progression of PBC when started at an early stage and reduces the likelihood of liver transplantation or death in moderate to severe PBC 1
The European Association for the Study of the Liver suggests UDCA is beneficial in cholestatic liver diseases, particularly in PBC, where it has strong evidence supporting its use 2

The American College of Gastroenterology states that UDCA is not recommended for non-alcoholic fatty liver disease (NAFLD) or non-alcoholic steatohepatitis (NASH) due to lack of evidence supporting its efficacy 3
In primary sclerosing cholangitis (PSC), high-dose UDCA has been associated with worse outcomes and is not recommended for routine use by the American Gastroenterological Association 3
The British Society of Gastroenterology recommends that UDCA may have a role in overlap syndromes such as AIH/PBC overlap, but only as an adjunct to immunosuppressive therapy targeting the autoimmune component 4

The National Institute for Health and Care Excellence suggests corticosteroids remain the primary pharmacological intervention for severe alcoholic hepatitis, not UDCA 5
The American College of Cardiology is not relevant here, instead, the American Liver Foundation states that abstinence from alcohol is the cornerstone of management for all alcohol-related liver diseases 5
The European Society for Clinical Nutrition and Metabolism recommends nutritional support is essential in the management of alcoholic hepatitis, as malnutrition often complicates the clinical course 5