{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T20:19:46Z","timestamp":1760473186416,"version":"build-2065373602"},"reference-count":23,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2023,1,3]],"date-time":"2023-01-03T00:00:00Z","timestamp":1672704000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Although laparoscopic cholecystectomy is the preferred treatment method in patients who experience typical biliary pain with or without gallstones, medical treatment has not been extensively studied. Rowachol is a potent choleretic agent, comprising six cyclic monoterpenes. This study aimed to investigate the clinical improvement and changes in gallbladder ejection fraction (GBEF) by Rowachol treatment in patients with typical biliary pain. Materials and Methods: We retrospectively reviewed 138 patients with typical biliary pain who underwent cholescintigraphy from July 2016 to April 2022. We included patients who received Rowachol for more than 2 months and underwent follow-up GBEF measurements. Finally, we analyzed pre- and post-treatment symptoms and GBEF. GBEF was calculated using the fatty meal-stimulated cholescintigraphy. Results: This retrospective observational study included 31 patients; their median age was 46.0 (range, 26.0\u201372.7) years, and 22 (71.0%) were female. Overall, 9 (29.0%) patients had gallbladder stones or sludges (maximum size: 2 mm) on initial transabdominal ultrasonography. During a median follow-up of 23.3 months, the symptoms of 21 (67.7%) patients were resolved after a median Rowachol treatment of 10.0 months. The mean GBEF was significantly improved after Rowachol treatment (initial cholescintigraphy: 42.6% \u00b1 16.2%; follow-up cholescintigraphy: 53.0% \u00b1 18.1%, p = 0.012). In patients with a GBEF \u226435% (n = 9), Rowachol significantly increased the GBEF from 21.3% \u00b1 8.3% to 49.1% \u00b1 20.7% (p = 0.008). Conclusions: Rowachol may have beneficial medical effects that can improve gallbladder dysfunction and treatment response.<\/jats:p>","DOI":"10.3390\/medicina59010105","type":"journal-article","created":{"date-parts":[[2023,1,4]],"date-time":"2023-01-04T01:42:44Z","timestamp":1672796564000},"page":"105","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Effect of Rowachol on the Gallbladder Dysmotility Disorder Based on Gallbladder Ejection Fraction"],"prefix":"10.3390","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3619-4340","authenticated-orcid":false,"given":"Sang Hoon","family":"Lee","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4167-3060","authenticated-orcid":false,"given":"Hyun Woo","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Nuclear Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1008-9814","authenticated-orcid":false,"given":"Tae Yoon","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Young Koog","family":"Cheon","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul 05030, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,1,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1420","DOI":"10.1053\/j.gastro.2016.02.033","article-title":"Rome iv. Gallbladder and sphincter of oddi disorders","volume":"15","author":"Cotton","year":"2016","journal-title":"Gastroenterology"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"The Rome Group for Epidemiology and Prevention of Cholelithiasis (GREPCO) (1988). The epidemiology of gallstone disease in Rome, Italy. Part I. Prevalence data in men. Hepatology, 8, 904\u2013906.","DOI":"10.1002\/hep.1840080433"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1002\/hep.1840070520","article-title":"A population study on the prevalence of gallstone disease: The sirmione study","volume":"7","author":"Barbara","year":"1987","journal-title":"Hepatology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1498","DOI":"10.1053\/j.gastro.2005.11.063","article-title":"Functional gallbladder and sphincter of oddi disorders","volume":"130","author":"Behar","year":"2006","journal-title":"Gastroenterology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"167","DOI":"10.1046\/j.1365-2036.2003.01654.x","article-title":"Systematic review and meta-analysis: Does gall-bladder ejection fraction on cholecystokinin cholescintigraphy predict outcome after cholecystectomy in suspected functional biliary pain?","volume":"18","author":"Cremonini","year":"2003","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2605","DOI":"10.1111\/j.1572-0241.2003.08772.x","article-title":"Does gallbladder ejection fraction predict outcome after cholecystectomy for suspected chronic acalculous gallbladder dysfunction? A systematic review","volume":"98","author":"DiBaise","year":"2003","journal-title":"Am. J. Gastroenterol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1016\/S0016-5085(98)70373-7","article-title":"Bile lithogenicity and gallbladder emptying in patients with microlithiasis: Effect of bile acid therapy","volume":"115","author":"Sharma","year":"1998","journal-title":"Gastroenterology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1136\/gut.20.4.312","article-title":"Rowachol--a possible treatment for cholesterol gallstones","volume":"20","author":"Doran","year":"1979","journal-title":"Gut"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1156","DOI":"10.2174\/1389557514666141127145820","article-title":"An overview of the pharmacological properties and potential applications of natural monoterpenes","volume":"14","author":"Koziol","year":"2014","journal-title":"Mini Rev. Med. Chem."},{"key":"ref_10","first-page":"726","article-title":"Therapy of bile duct diseases with a terpene combination","volume":"19","author":"Blumenberg","year":"1957","journal-title":"Medizinische"},{"key":"ref_11","unstructured":"(2002). The effect of rowachol\u00ae for the patients with gallbladder stones. Korean J. Pancreas Biliary Tract., 7, 83\u201387."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1136\/gut.29.4.428","article-title":"Dissolution of gall stones with an ursodeoxycholic acid menthol preparation: A controlled prospective double blind trial","volume":"29","author":"Leuschner","year":"1988","journal-title":"Gut"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"344","DOI":"10.1016\/j.jclinepi.2007.11.008","article-title":"The strengthening the reporting of observational studies in epidemiology (strobe) statement: Guidelines for reporting observational studies","volume":"61","author":"Altman","year":"2008","journal-title":"J. Clin. Epidemiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"180","DOI":"10.1001\/archsurg.2008.543","article-title":"Meta-analysis of cholecystectomy in symptomatic patients with positive hepatobiliary iminodiacetic acid scan results without gallstones","volume":"144","author":"Mahid","year":"2009","journal-title":"Arch. Surg."},{"key":"ref_15","first-page":"97","article-title":"Rowachol-cholex, a preparation containing terpenes, in the treatment of cholelithiasis","volume":"9","author":"Sarreither","year":"1955","journal-title":"Med. Monatsschr."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1136\/bmj.1.6155.24","article-title":"Gall stone dissolution in man using an essential oil preparation","volume":"1","author":"Bell","year":"1979","journal-title":"Br. Med. J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1136\/gut.26.1.32","article-title":"Effect of rowachol on biliary lipid secretion and serum lipids in normal volunteers","volume":"26","author":"Leiss","year":"1985","journal-title":"Gut"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1097\/00000441-198211000-00003","article-title":"Rowachol and ursodeoxycholic acid in hamsters with cholesterol gallstones","volume":"284","author":"Handelsman","year":"1982","journal-title":"Am. J. Med. Sci."},{"key":"ref_19","first-page":"115","article-title":"Enzymatic cleavage of conjugated glucuronic acids in relation to the problem of mineralysis","volume":"15","author":"Neuberg","year":"1951","journal-title":"Enzymologia"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"e21698","DOI":"10.1097\/MD.0000000000021698","article-title":"Litholytic agents as an alternative treatment modality in patients with biliary dyspepsia","volume":"99","author":"Kim","year":"2020","journal-title":"Medicine"},{"key":"ref_21","first-page":"611","article-title":"Adjunct to bile-acid treatment for gall-stone dissolution: Low-dose chenodeoxycholic acid combined with a terpene preparation","volume":"282","author":"Ellis","year":"1981","journal-title":"Br. Med. J. (Clin. Res. Ed.)"},{"key":"ref_22","first-page":"69","article-title":"Biliary dyskinesia and biliary crystals: A prospective study","volume":"63","author":"Velanovich","year":"1997","journal-title":"Am. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1257","DOI":"10.1053\/j.gastro.2016.03.035","article-title":"Functional gastrointestinal disorders: History, pathophysiology, clinical features and rome iv","volume":"4","author":"Drossman","year":"2016","journal-title":"Gastroenterology"}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/1\/105\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T17:57:10Z","timestamp":1760119030000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/1\/105"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,1,3]]},"references-count":23,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2023,1]]}},"alternative-id":["medicina59010105"],"URL":"https:\/\/doi.org\/10.3390\/medicina59010105","relation":{},"ISSN":["1648-9144"],"issn-type":[{"type":"electronic","value":"1648-9144"}],"subject":[],"published":{"date-parts":[[2023,1,3]]}}}