Email this article Comparative effectiveness of ursodeoxycholic acid preparations in the treatment of biliary sludge
- Authors: Butorova L.I.1, Ardatskaya M.D.2, Osadchuk M.A.1, Drobysheva A.E.3, Zagrebina E.A.4, Kadnikova N.G.5, Kalashnikova M.A.6, Lukianova E.I.7, Pavlova L.N.8, Plavnik R.G.9, Sayutina E.V.1, Topchiy T.B.2, Trunova S.N.10, Tuayeva E.M.1, Shustova N.U.10
-
Affiliations:
- Sechenov First Moscow State Medical University (Sechenov University)
- Central State Medical Academy
- Private Healthcare Institution “Central clinical hospital “RZD-Medicine” (NCC RZD “Medicine”)
- Treatment and Rehabilitation Center
- Central Clinical Hospital for Rehabilitation Treatment, Goluboe village
- Joint Hospital and Polyclinic
- City Polyclinic №201
- Axis Medical Center
- ISOCARB
- Clinic K+31
- Issue: Vol 92, No 8 (2020)
- Pages: 60-65
- Section: Original articles
- URL: https://journals.rcsi.science/0040-3660/article/view/43542
- DOI: https://doi.org/10.26442/00403660.2020.08.000700
- ID: 43542
Cite item
Full Text
Abstract
In the clinical classification of cholelithiasis, biliary sludge (BS) is distinguished as the pre-stone stage. Ursodeoxycholic acid (UDCA) is a drug with an evidence base for effective and safe effects on BS. The therapeutic equivalence of various UDCA drugs remains an important issue for clinical practice.
Aim. To conduct a comparative analysis of the effectiveness of the use of UDCA: Ursofalk with other UDCA drugs for the treatment of BS in a fixed dose of 10 mg/kg of body weight.
Material and methods. The observation group consisted of 225 patients with various types of BS. In randomized groups, the comparison of the effectiveness of UDCA drugs in the dissolution of BS was determined by the data of ultrasound of the gallbladder. Dynamic ultrasound cholecystography using a standardized technique was performed to study the effect of the compared drugs on the contractile function of the liver. When analyzing the impact of ursotherapy on the clinical manifestations of BS, the dynamics of biliary pain syndrome and dyspeptic disorders were evaluated.
Results. A comparative analysis of the effectiveness of UDCA drugs for BS lysis with a high degree of confidence established the advantage of Ursofalk: after 3 months in 80%, and after 6 months of therapy in 95.65% of patients, a regression of BS was detected. In the group of patients who took other UDCA, the corresponding indicators were 46.36% and 67.27%. The greatest effectiveness of ursotherapy was demonstrated in the BS variant by the type of suspension of hyperechogenic particles, the lowest in the variant by the type of putty-like bile in the form of mobile or fixed clots. In the last variant of BS, the relationship between the success of lysis with the extension of the UDCA intake period to 6 months and the preferred choice of Ursofalk was traced. Normalization of the contractile function of the gallbladder was noted in patients who took Ursofalk.
Conclusion. From the standpoint of therapeutic effectiveness, the drug of choice for the treatment of BS, regardless of its type, is Ursofalk, which has proven the best dynamics of BS litolysis, recovery of the contractile function of the gastrointestinal tract, and relief of clinical symptoms.
Keywords
Full Text
##article.viewOnOriginalSite##About the authors
L. I. Butorova
Sechenov First Moscow State Medical University (Sechenov University)
Author for correspondence.
Email: ludmilabutorova@mail.ru
ORCID iD: 0000-0003-4689-2844
к.м.н., доц. каф. поликлинической терапии Института клинической медицины им. Н.В. Склифосовского ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» (Сеченовский Университет)
Russian Federation, MoscowM. D. Ardatskaya
Central State Medical Academy
Email: ludmilabutorova@mail.ru
ORCID iD: 0000-0001-8150-307X
д.м.н., проф. каф. гастроэнтерологии ФГБУ ДПО ЦГМА
Russian Federation, MoscowM. A. Osadchuk
Sechenov First Moscow State Medical University (Sechenov University)
Email: ludmilabutorova@mail.ru
ORCID iD: 0000-0003-0485-6802
д.м.н., проф., зав. каф. поликлинической терапии Института клинической медицины им. Н.В. Склифосовского ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» (Сеченовский Университет)
Russian Federation, MoscowA. E. Drobysheva
Private Healthcare Institution “Central clinical hospital “RZD-Medicine” (NCC RZD “Medicine”)
Email: ludmilabutorova@mail.ru
ORCID iD: 0000-0002-1131-9127
врач-гастроэнтеролог высшей квалификационной категории, НКЦ РЖД «Медицина»
Russian Federation, MoscowE. A. Zagrebina
Treatment and Rehabilitation Center
Email: ludmilabutorova@mail.ru
ORCID iD: 0000-0002-9896-0012
к.м.н., гастроэнтеролог, ФБУЗ ЛРЦ
Russian Federation, MoscowN. G. Kadnikova
Central Clinical Hospital for Rehabilitation Treatment, Goluboe village
Email: ludmilabutorova@mail.ru
ORCID iD: 0000-0002-8228-0522
зав. отд-нием, врач-гастроэнтеролог ФГБУЗ ЦКБВЛ
Russian Federation, Moscow regionM. A. Kalashnikova
Joint Hospital and Polyclinic
Email: ludmilabutorova@mail.ru
ORCID iD: 0000-0003-2606-198X
гастроэнтеролог, ФГБУ ОБП
Russian Federation, MoscowE. I. Lukianova
City Polyclinic №201
Email: ludmilabutorova@mail.ru
ORCID iD: 0000-0002-4989-9964
врач-гастроэнтеролог высшей квалификационной категории, внештатный специалист-гастроэнтеролог Зеленоградского округа г. Москвы, ГБУЗ ГП №201
Russian Federation, MoscowL. N. Pavlova
Axis Medical Center
Email: ludmilabutorova@mail.ru
ORCID iD: 0000-0001-8675-429X
врач-гастроэнтеролог высшей квалификационной категории, ООО МЦ «Аксис»
Russian Federation, ZelenogradR. G. Plavnik
ISOCARB
Email: ludmilabutorova@mail.ru
ORCID iD: 0000-0001-5448-8812
к.м.н., зам. ген. дир. по науке и внедрению ООО «ИЗОКАРБ»
Russian Federation, MoscowE. V. Sayutina
Sechenov First Moscow State Medical University (Sechenov University)
Email: ludmilabutorova@mail.ru
ORCID iD: 0000-0001-9611-5096
к.м.н., ассистент каф. поликлинической терапии Института клинической медицины им. Н.В. Склифосовского ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» (Сеченовский Университет)
Russian Federation, MoscowT. B. Topchiy
Central State Medical Academy
Email: ludmilabutorova@mail.ru
ORCID iD: 0000-0003-4491-881X
к.м.н., доц. каф. гастроэнтерологии ФГБУ ДПО ЦГМА
Russian Federation, MoscowS. N. Trunova
Clinic K+31
Email: ludmilabutorova@mail.ru
ORCID iD: 0000-0001-9523-9820
врач-гастроэнтеролог АО «Клиника К+31»
Russian Federation, YaroslavlE. M. Tuayeva
Sechenov First Moscow State Medical University (Sechenov University)
Email: ludmilabutorova@mail.ru
ORCID iD: 0000-0002-6542-2277
к.м.н., ассистент каф. поликлинической терапии Института клинической медицины им. Н.В. Склифосовского ФГАОУ ВО «Первый МГМУ им. И.М. Сеченова» (Сеченовский Университет)
Russian Federation, MoscowN. U. Shustova
Clinic K+31
Email: ludmilabutorova@mail.ru
ORCID iD: 0000-0001-9190-3982
гастроэнтеролог, ФБУЗ ЛРЦ
Russian Federation, YaroslavlReferences
- Ивашкин В.Т., Маев И.В., Баранская Е.К. и др. Рекомендации Российской гасроэнтерологической ассоциации по диагностике и лечению желчнокаменной болезни. Рос. журн. гастроэнтерологии, гепатологии, колопроктологии. 2016;26(3):64-80 [Ivashkin VT, Mayev IV, Baranskaya YK, et al. Gallstone disease diagnosis and treatment: guidelines of the Russian gastroenterological association. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2016;26(3):64-80 (In Russ.)]. doi: 10.22416/1382-4376-2016-26-3-64-80
- Абгаджава Э.З., Тельных Ю.В. Патогенетическая терапия и исходы сладжа желчного пузыря. Экспериментальная и клиническая гастроэнтерология. 2016;128(4):67-71 [Abgadzhava EZ, Telnykh YV. Pathogenetic therapy and of the gallbladder sludge outcomes. Experimental and Clinical Gastroenterology. 2016;128(4):67-71 (In Russ.)].
- Минушкин О.Н., Елизаветина Г.А., Иванова О.И., Шапошникова О.Ф. Урсодезоксихолевая кислота в лечении больных с билиарным сладжем. Эффективная фармакотерапия. Гастроэнтерология. 2012;3:10-2 [Minushkin ON, Elizavetina GA, Ivanova OI, Shaposhnikova OF. Ursodeoxycholic acid in the treatment of patients with biliary sludge. Effective pharmacotherapy. Gastroenterology. 2012;3:10-2 (In Russ.)].
- Казюлин А.Н., Гончаренко А.Ю., Калягин И.Е. Применение урсодезоксихолевой кислоты в профилактике и лечении желчнокаменной болезни в практике врачей «первого контакта». РМЖ. Медицинское обозрение. 2017;2:80-7 [Kazyulin AN, Goncharenko AYu, Kalyagin IE. Application of ursodezoxycolic acid for prevention and treatment of cholelithiasis in the practice of the «first contact physicians. RMJ Medical review. 2017;2:80-7 (In Russ.)].
- Portincasa P, Ciaula AD, Bonfrate L, Wang DQ. Therapy of gallstone disease: What it was, what it is, what it will be. World J Gastrointest Pharmacol Ther. 2012;3(2):7-20. doi: 10.4292/wjgpt.v3.i2.7
- Guarino MPL, Cong P, Cicala M et al. Ursodeoxycholic acid improves muscle contractility and inflammation in symptomatic gallbladders with cholesterol gallstones. Gut. 2007;56(6):815-20. doi: 10.1136/gut.2006.109934
- Ильченко А.А. Обоснование применения урсодеоксихолевой кислоты при функциональных нарушениях билиарного тракта. Экспериментальная и клиническая гастроэнтерология. 2011;9:108-12 [Ilchenko AA. Rationale for the use of ursodeoxycholic acid in functional disorders of the biliary tract. Experimental and clinical gastroenterology. 2011;9:108-12 (In Russ.)].
- Свистунов А.А., Буторова Л.И., Осадчук М.А. Синдром билиарной боли в свете Римских критериев IV: рациональный подход к выбору спазмолитической терапии в клинической практике. Доказательная гастроэнтерология. 2018;7(2):59-69 [Svistunov AA, Butorova LI, Osadchuk MA et al. The biliary pain syndrome in the context of the Rome IV diagnostic criteria: the rational approach to the choice of spasmolytic therapy in the clinical practice. Evidence-based gastroenterology. 2018;7(2):59-69 (In Russ.)]. doi: 10.17116/dokgastro20187259
- Behar J, Lee KY, Tompson WR, Biancani P. Gallbladder contraction in patients with pigment and cholesterol stones. Gastroenterology. 1989;97(6):1479-84. doi: 10.1016/0016-5085(89)90392-2
- Xiao ZL, Biancani P, Carey MC, Behar J. Hydrophilic but not hydrophobic bile acids prevent gallbladder muscledysfunction in acute cholecystitis. Hepatology. 2003;37(6):1442-50. doi: 10.1053/jhep.2003.50243
- Portincasa P, Di Ciaula A, van Berge-Henegouwen GP. Smooth muscle function and dysfunction in gallbladder disease. Curr Gastroenterol Rep. 2004;6(2):151-62. doi: 10.1007/s11894-004-0043-0
