Metabolically associated fatty liver disease and cholelithiasis – depressing comorbidity in XXI century: A review

Metabolically associated fatty liver disease (MAFLD) is one of the most common liver diseases found in 25–30% of the adult population. Similarly, cholelithiasis is one of the most common pathologies of the biliary tract worldwide, which is diagnosed in 10–20% of the adult population. Cholesterol concretions are common components of the gastrointestinal tract, the pathogenesis of which is significantly influenced by metabolic factors such as dyslipidemia, obesity, insulin resistance and rapid weight loss. The review highlights the mechanisms of concretion formation in patients with MAFLD in terms of the effect of various components of the metabolic syndrome on impaired gallbladder motility and bile lithogenicity. Aspects of the progression of biliary pathology from Oddi sphincter dysfunction to the formation of chronic stone-free cholecystitis, sludge syndrome, and further to gallstone disease and postcholecystectomy syndrome, called biliary continuum, are noted. The mechanisms of concretion formation associated with the liver, intestinal microbiota, hyperinsulinemia, and insulin resistance are described. The nonspecific and systemic nature of the holinoblocking effect of neurotropic antispasmodics is noted, as a result of which their limited use in gastroenterology is noted. The opinion of experts is given on a more preferable strategy for prescribing antispasmodics with minimal systemic effects, in particular, the selective myotropic antispasmodic mebeverine hydrochloride (200 mg 2 times a day orally). The results demonstrating the effectiveness of Duspatalin in relieving pain associated with gallbladder and Oddi sphincter dysfunction, including after cholecystectomy, in patients with physico-chemical and clinically pronounced stages of cholelithiasis, as well as with biliary sludge, are presented. Special attention is paid to the treatment of the comorbid course of MAFLD and cholelithiasis. It is shown that in patients with MAFLD and biliary comorbidity (with sludge syndrome, formed concretions in the gallbladder), the approach of complex therapy with ademetionine (the original drug Heptral®) and mebeverine (the original drug Duspatalin®) seems extremely rational. Due to the complementary clinical effects, the use of this strategy improves liver function from the inside, the outflow of bile acids into the biliary tract, the outflow of bile, and the relief of cramps and pain.