[Biliary sludge: pathogenesis, etiology and drug therapy]

[Stage I cholelithiasis. Approaches to diagnosis and treatment. Results of the Machaon study]

AIM

To review the results of the open observational study Makhaon on the use of a fixed combination of glycyrrhizic acid (GA) and ursodeoxycholic acid (UDCA) (Phosphogliv Urso) for the treatment of abdominal pain, assessment of contractile function of the gallbladder and bile rheology in patients with stage I cholelithiasis.

MATERIALS AND METHODS

The study included 330 subjects, 44.5% males and 55.5% females. The study participants were 18-70 years old, with a mean age of 43.8±0.6 years. In 2021-2022, patients were treated in 14 clinical centers in 10 cities of the Russian Federation: Moscow, St. Petersburg, Stavropol, Volgograd, Perm, Samara, Ufa, Omsk, Novosibirsk, Tomsk. All patients received Phosphogliv Urso (UDCA 250 mg + sodium glycyrrhizinate 35 mg), 1 capsule 3 times daily with food for 6 months.

RESULTS

Based on the clear improvement, therapy with a combination of GA and UDCA has demonstrated high efficacy and safety and appears to be optimal for the treatment of abdominal pain, improvement of the contractile function of the gallbladder, and physicochemical properties of bile in patients with stage I cholelithiasis.

CONCLUSION

Treating all variants of baseline changes in the bile rheology is an urgent task of modern biliology. Universal drugs for stage I cholelithiasis are UDCA and its fixed combination with GA.

The effect of ursodeoxycholic acid in dissolving gallstones formed after laparoscopic sleeve gastrectomy: retrospective cohort study

PURPOSE

Rapid weight loss that often occurs after laparoscopic sleeve gastrectomy (LSG) has been linked to an increased risk of gallstone formation. This study aimed to investigate whether ursodeoxycholic acid could be an effective alternative treatment for gallstone dissolution, potentially offering a nonsurgical option for patients requiring gallstone removal.

METHODS

This retrospective study analyzed 88 patients who underwent LSG and subsequently developed gallstones between 2017 and 2023. Fifty-one patients who received UDCA treatment were compared to 37 patients who did not receive UDCA. Demographic and clinical characteristics and gallstone dissolution rates were analyzed using SPSS v25.0.

RESULTS

Gallstones dissolved in 60% of patients who received UDCA treatment, and symptoms such as dyspepsia decreased. A stone diameter of less than 5 mm was associated with a higher treatment success rate. The number of hospitalizations and admissions due to gallstone symptoms has decreased. The side effects were mild and did not require treatment discontinuation.

CONCLUSIONS

UDCA treatment is an effective option for the resolution of gallstones after LSG. However, surgery may be more appropriate for treating larger stones. The results of this study suggest that UDCA is an effective intervention for reducing gallstone-related complications following LSG.

Evaluation of therapeutic efficiency of various drugs of ursodeoxycholic acid in the treatment of biliary sludge

Background. Biliary sludge (BS) refers to the pre-stone stage of gallstone disease. Timely treatment of this condition with ursodeoxycholic acid (UDCA) drugs helps prevent the progression of the disease. However, not all drugs used in practice are equally effective in relieving clinical manifestations, resolving sludge according to ultrasound results and tolerance. Aim. To evaluate the therapeutic efficacy of the drug Ursofalk in comparison with other UDCA drugs used for the treatment of BS. Materials and methods. We examined 105 people with different types of BS identified during ultrasound examination (US); they were divided into 2 groups depending on the UDCA drug taken. In patients, the dynamics of clinical manifestations was assessed using a questionnaire, as well as the dynamics of the ultrasound picture while taking UDCA. Results. Statistical analysis showed that Ursofalk significantly better relieves biliary pain (p=0.025) and biliary dyspepsia (p=0.039), pain regression occurs faster (p=0.01) in 21 days. It also has a better tolerance in 94.34% of cases compared to other drugs 67.31% (p=0.017). Ursofalk has a greater effect on the regression of BS according to ultrasound results after 3 months (p=0.022) and 6 months (p=0.016). Conclusion. The drug studied by us demonstrated high efficiency in relation to patients with BS, while there were minimal side effects, which led to a better tolerability of therapy.