Therapeutic Efficacy And Clinical Outcomes Of Ursodeoxycholic Acid In Gallstone Disease And Metabolic Liver Disorders: A Narrative Review

Ursodeoxycholic acid (UDCA) is a hydrophilic bile acid used in selected hepatobiliary disorders and cholesterol gallstone disease, with increasing interest in its cytoprotective, anti-inflammatory, and metabolic effects in metabolic dysfunction-associated steatotic liver disease (MASLD). This narrative review aimed to evaluate the therapeutic efficacy, clinical outcomes, safety, and limitations of UDCA in gallstone disease and metabolic liver disorders. Literature was identified from PubMed, ScienceDirect, and Google Scholar, prioritizing studies published between 2021 and 2026, while earlier landmark randomized trials were included when essential to assess dose, histological outcomes, or long-term efficacy. The evidence was analyzed qualitatively and synthesized thematically according to pharmacological mechanisms, gallstone prevention and dissolution, biochemical and histological liver outcomes, safety, dosing, and the potential dual role of UDCA in coexisting MASLD and gallstone disease. UDCA showed the greatest benefit in selected patients with small, radiolucent, cholesterol-rich, newly formed gallstones or biliary sludge and may reduce post-bariatric gallstone formation, biliary symptoms, hospital utilization, and the need for intervention. In metabolic liver disorders, UDCA consistently improved biochemical markers, particularly ALT, AST, and GGT, but these effects did not consistently translate into histological improvement or fibrosis regression. These findings indicate that UDCA has stronger evidence as a selective therapy for cholesterol gallstone disease than as a disease-modifying treatment for MASLD. Its role in metabolic liver disorders is best considered adjunctive, while direct evidence of simultaneous hepatic and biliary benefit remains limited.