Results of oral litholysis with ursodeoxycholic acid in a patient with cholesterol cholecystolithiasis
- Authors: Seliverstov P.V.1, Radchenko V.G.1, Dudanova O.P.2, Larina N.A.2, Kurbatova I.V.3, Shipovskaya A.А.2
-
Affiliations:
- Kirov Military Medical Academy
- Petrozavodsk State University
- Karelian Research Center of Russian Academy of Sciences
- Issue: Vol 96, No 12 (2024): VARIO (РАЗНОЕ)
- Pages: 1206-1210
- Section: Original articles
- URL: https://journals.rcsi.science/0040-3660/article/view/280697
- DOI: https://doi.org/10.26442/00403660.2024.12.203076
- ID: 280697
Cite item
Full Text
Abstract
Materials and methods. The study involved 58 patients with cholelithiasis: 56.9% – with stones and 43.1% – with biliary sludge; women – 60.3%, men – 39.7%, the average age of the examined was 60.5±11.6 years. The asymptomatic course was in 46.6% of patients, and the pain syndrome was registered in 53.4%. The diagnosis was verified based on the results of ultrasound examination of the abdominal organs, the X-ray transparency of the concretions was confirmed by X-ray examination and computed tomography. Single stones were found in 63.6% of the patient and double stones in 36.4% of patients. The size of the concretions was 7.71±4.15 mm (3–15 mm). All patients had from 3 to 5 signs of metabolic syndrome. Patients took UDCA at a dose of 10–13 mg / kg for 6–24 months.
Results. There was a positive clinical picture in most patients. Biliary sludge ceased to be detected in all patients after 3–6 months, concretions less than 5 mm – after 6 months. Larger stones of 5–10 mm completely dissolved after 12 months, in 4 patients with stones of 14–15 mm, after 18–24 months, the concretions decreased to 5–7 mm.
Conclusion. UDCA at a dose of 10–13 mg/kg had a 100-percent effect on the dissolution of biliary sludge after 3–6 months and 79.3% result – with respect to the dissolution of concretions within 12–24 months. In parallel, UDCA demonstrated an anti-inflammatory effect, decreased inflammatory markers and decreased endotoxin levels in the blood, as well as improved glucose and lipid metabolism.
Full Text
##article.viewOnOriginalSite##About the authors
Pavel V. Seliverstov
Kirov Military Medical Academy
Author for correspondence.
Email: seliverstov-pv@yandex.ru
ORCID iD: 0000-0001-5623-4226
канд. мед. наук, доц.
Russian Federation, Saint PetersburgValerii G. Radchenko
Kirov Military Medical Academy
Email: seliverstov-pv@yandex.ru
ORCID iD: 0000-0002-2964-9167
д-р мед. наук, проф.
Russian Federation, Saint PetersburgOlga P. Dudanova
Petrozavodsk State University
Email: seliverstov-pv@yandex.ru
ORCID iD: 0000-0003-2613-5694
д-р мед. наук, проф., зав. каф.
Russian Federation, PetrozavodskNadezhda A. Larina
Petrozavodsk State University
Email: seliverstov-pv@yandex.ru
ORCID iD: 0000-0002-0255-4053
канд. мед. наук. доц. каф.
Russian Federation, PetrozavodskIrina V. Kurbatova
Karelian Research Center of Russian Academy of Sciences
Email: seliverstov-pv@yandex.ru
ORCID iD: 0000-0001-7620-7065
канд. биол. наук, ст. науч. сотр. лаб.
Russian Federation, PetrozavodskAnastasia А. Shipovskaya
Petrozavodsk State University
Email: seliverstov-pv@yandex.ru
ORCID iD: 0000-0003-3830-6446
канд. мед. наук, доц. каф.
Russian Federation, PetrozavodskReferences
- Ивашкин В.Т., Маев И.В., Баранская Е.К., и др. Рекомендации Российской гастроэнтерологической ассоциации по диагностике и лечению желчнокаменной болезни. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2016;26(3):64-80 [Ivashkin VT, Mayev IV, Baranskaya YeK, 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 Russian)]. doi: 10.22416/1382-4376-2016-26-3-64-80
- Hall L, Halle-Smith J, Evans R, et al. Ursodeoxycholic acid in the management of symptomatic gallstone disease: systematic review and clinician survey. BJS Open. 2023;7(2):zrac152. doi: 10.1093/bjsopen/zrac152
- Радченко В.Г., Селиверстов П.В., Леденцова С.С., Маньяков А.В. Неалкогольный стеатогепатит и билиарный сладж у лиц с метаболическим синдромом. Терапевтический архив. 2016;88(9):78-83 [Radchenko VG, Seliverstov PV, Ledentsova SS, Manyakov AV. Nonalcoholic steatohepatitis and biliary sludge in people with metabolic syndrome. Terapevticheskii Arkhiv (Ter. Arkh.). 2016;88(9):78-83 (in Russian)]. doi: 10.17116/terarkh201688978-83
- Маньяков А.В., Селиверстов П.В., Радченко В.Г. Профилактика неалкогольной жировой болезни печени у пациентов с желчнокаменной болезнью после холецистэктомии. Экспериментальная и клиническая гастроэнтерология. 2018;(2):44-50 [Maniakov AV, Seliverstov PV, Radchenko VG. Prevention of non-alcoholic fatty liver disease in patients with cholelithiasis after cholecystectomy. Experimental and Clinical Gastroenterology. 2018;(2):44-50 (in Russian)].
- Радченко В.Г., Сафроненкова И.Г., Ситкин С.И., и др. Медикаментозный литолиз препаратом Урсофальк. Усовершенствованная медицинская технология. СПб., 2010. 20 c. [Radchenko VG, Safronenkova IG, Sitkin SI, et al. Medikamentoznyi litoliz preparatom Ursofal'k. Usovershenstvovannaia meditsinskaia tekhnologiia. Saint Petersburg, 2010. 20 s. (in Russian)].
- Лейшнер У. Практическое руководство по заболеваниям желчных путей. М.: ГЭОТАР-МЕД, 2001 [Leishner U. Prakticheskoe rukovodstvo po zabolevaniiam zhelchnykh putei. Moscow: GEOTAR-MED, 2001 (in Russian)].
- Радченко В.Г., Селиверстов П.В., Приходько Е.М., и др. Возможности клинического применения урсодезоксихолевой кислоты. Вестник терапевта. 2022;1(52) [Radchenko VG, Seliverstov PV, Prikhodko EM, et al. Possibilities of clinical application of ursodeoxycholic acid. Herald of the Therapist. 2022;1(52) (in Russian)].
- Радченко В.Г., Селиверстов П.В., Ситкин С.И. Новые аспекты фармакологического действия урсодезоксихолевой кислоты. Экспериментальная и клиническая гастроэнтерология. 2014;(8):4-10 [Radchenko VG, Seliverstov PV, Sitkin SI. New aspects of pharmacological effects of ursodeoxycholic acid. Ehksperimental’naya i klinicheskaya gastroehnterologiya. 2014;(8):4-10 (in Russian)].
- Яковенко Э.П., Вялов С.С. Безопасность урсодезоксихолевой кислоты: доказательства или слухи о токсичности? Consilium Medicum. 2017;19(8):27-31 [Yakovenko EP, Vialov SS. Safety of ursodeoxycholic acid: Evidence or rumors about toxicity? Consilium Medicum. 2017;19(8):27-31 (in Russian)]. doi: 10.26442/2075-1753_19.8.27-31
- Кучерявый Ю.А., Морозов С.В. Гепатопротекторы в клинической практике: рациональные аспекты использования. Пособие для врачей. М.: Прима принт, 2015 [Kucheriavyi IuA, Morozov SV. Gepatoprotektory v klinicheskoi praktike: ratsional'nye aspekty ispol'zovaniia. Posobie dlia vrachei. Moscow: Prima Print, 2015 (in Russian)].
- Авалуева Е.Б., Ситкин С.И., Бакулин И.Г., и др. Билиарный сладж и желчнокаменная болезнь: диагностика, лечение и профилактика. М.: Прима Принт, 2023 [Avalueva EB, Sitkin SI, Bakulin IG, et al. Biliarnyi sladzh i zhelchnokamennaia bolezn': diagnostika, lechenie i profilaktika. Moscow: Prima Print, 2023 (in Russian)].
- Бакулин И.Г., Авалуева Е.Б., Серкова М.Ю., и др. Билиарный сладж: патогенез, этиология и лекарственная терапия. Терапевтический архив. 2021;93(2):179-86 [Bakulin IG, Avalueva EB, Serkova MU, et al. Biliary sludge: Pathogenesis, etiology and drug therapy. Terapevticheskii Arkhiv (Ter. Arkh.). 2021;93(2):179-86 (in Russian)]. doi: 10.26442/00403660.2021.02.200638
- Кучерявый Ю.А., Черемушкин С.В. Оценка терапевтической эффективности референтного препарата урсодезоксихолевой кислоты и его аналогов в растворении билиарного сладжа: метаанализ. Consilium Medicum. 2022;24(12):860-4 [Kucheryavyy YA, Cheremushkin SV. Therapeutic efficacy evaluation of the reference drug ursodeoxycholic acid and its analogues in the biliary sludge dissolution: A meta-analysis. Consilium Medicum. 2022;24(12):860-4 (in Russian)]. doi: 10.26442/20751753.2022.12.201429
- Gutt C, Jenssen C, Barreiros AP, et al.; Diagnostik und Behandlung von Gallensteinen. [Updated S3-Guideline for Prophylaxis, Diagnosis and Treatment of Gallstones. German Society for Digestive and Metabolic Diseases (DGVS) and German Society for Surgery of the Alimentary Tract (DGAV) – AWMF Registry 021/008]. Z Gastroenterol. 2018;56(8):912-66 (in German). doi: 10.1055/a-0644-2972
- Буторова Л.И., Ардатская М.Д., Осадчук М.А., и др. Сравнительная эффективность урсодеоксихолевой кислоты в лечении билиарного сладжа. Терапевтический архив. 2020;92(8):60-5 [Butorova LI, Ardatskaya MD, Osadchuk MA, et al. Comparative effectiveness of ursodeoxycholic acid preparations in the treatment of biliary sludge. Terapevticheskii Arkhiv (Ter. Arkh.). 2020;92(8):60-5 (in Russian)]. doi: 10.26442/00403660.2020.08.000700
- Селиверстов П.В., Скворцова Т.Э., Ситкин С.И., Радченко В.Г. Возможности терапевтического лечения больных желчнокаменной болезнью. Медицинский совет. 2019;(14):44-51 [Seliverstov PV, Skvortsova TE, Sitkin SI, Radchenko VG. Treatment options for patients with gallstones (cholelithiasis). Meditsinskiy sovet = Medical Council. 2019;(14):44-51 (in Russian)]. doi: 10.21518/2079-701X-2019-14-44-51
- Исанбаева А.Р., Сахаутдинова Г.М. Оценка терапевтической эффективности различных препаратов урсодезоксихолиевой кислоты в лечении билиарного сладжа. Терапевтический архив. 2021;93(12):1477-81 [Isanbaeva AR, Sakhautdinova GM. Evaluation of therapeutic efficiency of various drugs of ursodeoxycholic acid in the treatment of biliary sludge. Terapevticheskii Arkhiv (Ter. Arkh.). 2021;93(12):1477-81 (in Russian)]. doi: 10.26442/00403660.2021.12.201250
- 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
- Цуканов В.В., Онучина Е.В., Васютин А.В., Тонких Ю.Л. Опыт применения урсодезоксихолевой кислоты для растворения желчных камней. Медицинский совет. 2019;(21):160-5 [Tsukanov VV, Onuchina EV, Vasyutin AV, Tonkikh YuL. Experience of using ursodeoxycholic acid to dissolve gallstones. Meditsinskiy sovet = Medical Council. 2019;(21):160-5 (in Russian)]. doi: 10.21518/2079-701X-2019-21-160-165
- Lefebvre P, Cariou B, Lien F, et al. Role of bile acids and bile acid receptors in metabolic regulation. Physiol Rev. 2009;89(1):147-91. doi: 10.1152/physrev.00010.2008
- Perino A, Demagny H, Velazquez-Villegas L, Schoonjans K. Molecular physiology of bile acid signaling in health, disease, and aging. Physiol Rev. 2021;101(2):683-731. doi: 10.1152/physrev.00049.2019
- Rudling M, Laskar A, Straniero S. Gallbladder bile supersaturated with cholesterol in gallstone patients preferentially develops from shortage of bile acids. J Lipid Res. 2019;60(3):498-505. doi: 10.1194/jlr.S091199
Supplementary files
