The combined application of Ursodeoxycholic acid (UDCA) and probiotic complex ProbioLog may affect lithogenesis processes in the early stages of gallstone disease in elderly people
https://doi.org/10.31146/1682-8658-ecg-181-9-29-34
Abstract
The aim of the study was to evaluate the effectiveness of ursodeoxycholic acid (UDCA) in combination with ProbioLog at the early stage of gallstone disease in the elderly.
Material and methods: 92 patients with early stage of cholelithiasis (CL) were examined, the average age was 66,69 ± 5,52 years, there were 29 men and 63 women. In addition to anamnestic and general clinical data, the results of ultrasound examination (US) of the gallbladder were used to verify the diagnosis. The biochemical properties of bile (cholesterol, bile acids, phospholipids levels, bile lithogenicity indices) were studied. The composition of the intestinal microflora was determined using a hydrogen breath test with lactulose and culture of feces for dysbiosis. Two groups were formed due to the course of treatment, which amounted to 30 days. 45 patients of the observation group received UDCA 15 mg / kg per day once for a night in combination with the probiotic ProbioLog (Mayoly Spindler, France), 1 сapsule twice per day. UDCA monotherapy of 15 mg / kg daily was administered to 47 patients of the comparison group once for the night.
Results. After the course of treatment, a favorable dynamics of clinical symptoms of the disease was noted. According to US, elimination of biliary sludge was observed in 62.2% of patients of the observation group and in 14.8% of patients of the comparison group. An improvement in the biochemical composition of bile was manifested by decreasing of its lithogenic properties. The important results of therapy were positive changes in the composition of the intestinal microflora, contributing to the normalization of the exchange of bile acids, cholesterol and phospholipids.
Conclusion. The combined using of UDCA and ProbioLog in elderly patients is clinically effective in the treatment of early stages of cholelithiasis and pathogenetically justified in the prevention of gallstone formation.
About the Authors
N. N. GlazyrinaRussian Federation
Department of propaedeutics of internal diseases with a course of nursing, postgraduate student
426034, st. Kommunarov, 281, Izhevsk
N. A. Khokhlacheva
Russian Federation
Department of propaedeutics of internal diseases with the course of nursing, Professor, doctor
of medical Sciences
426034, st. Kommunarov, 281, Izhevsk
O. D. Mikhailova
Russian Federation
Department of propaedeutics of internal diseases with the course of nursing, associate Professor, candidate
of medical Sciences
426034, st. Kommunarov, 281, Izhevsk
E. V. Belova
Russian Federation
gastroenterologist, doctor of medical Sciences, associate Professor
426000, Izhevsk, st. Sovkhoznaya, 1A
References
1. Ильченко А. А. Болезни желчного пузыря и желчных путей: руководство для врачей.–Москва: МИА, 2011. 880 с. Il’chenko A. A. Bolezni zhelchnogo puzyrya i zhelchnyh putej: rukovodstvo dlya vrachej. [Diseases of the gallbladder and bile ducts: a guide for doctors]. Moscow, MIA, 2011. 880 p.
2. Лазебник Л. Б. Заболевания органов пищеварения у пожилых. – Москва Анахарсис, 2003. 185 с. Lazebnik L. B. Zabolevaniya organov pishchevareniya u pozhilyh. [Diseases of the digestive system in the elderly]. Moscow, Anaharsis, 2003. 185 р.
3. Хохлачева Н.А., Сергеева Н. Н., Вахрушев Я. М. Возрастные и гендерные особенности развития желчнокаменной болезни. Архивъ внутренней медицины. 2016;6(1):34–39. DOI: 10.20514/2226–6704–2016–6–1–34–39 Hohlacheva N. A., Sergeeva N. N., Vahrushev YA. M. Vozrastnye i gendernye osobennosti razvitiya zhelchnokamennoĭ bolezni. [Age and gender peculiarities of development of gallstone disease] Arhiv” vnutrennej mediciny, 2016, no. 6(1), pp. 34–39. DOI: 10.20514/2226–6704–2016–6–1–34–39
4. Михайлова Е. С. Микробиоценозы эзофагогастродуоденальной зоны у больных с патологией желчевыводящих путей. Автореф. дис. к. м. н., Москва, 2009, 24. Mihajlova E. S. Mikrobiocenozy ezofagogastroduodenal’noj zony u bol’nyh s patologiej zhelchevyvodyashchih putej. [Microbiocenoses of the esophagogastroduodenal zone in patients with biliary tract pathology]. Avtoref. dis. k. m. n. Moscow, 2009, 24 р.
5. Ljungh A. Wadstrom T. Lactic acid bacteria as probiotics. Сurr. Issues. Intest. Microbiol. – 2006; 7 (2): 73–89.
6. Егшатян Л. В., Ткачева О. Н., Кафарская Л. И. и соав. Изменения кишечной микрофлоры, ассоциированные с возрастом и образом жизни. Ожирение и метаболизм. 2015; 12 (2): 3–9. Egshatyan L. V., Tkacheva O. N., Kafarskaya L. I. i soav. Izmeneniya kishechnoj mikroflory, associirovannye s vozrastom i obrazom zhizni. [Changes in the intestinal microflora associated with age and lifestyle]. Ozhirenie i metabolizm. 2015, vol. 12, no. 2, 2015, pp. 3–9.
7. Самсонова Н.Г., Звенигородская Л. А., Черкашова Е. А., Лазебник Л. Б. Дисбиоз кишечника и атерогенная дислипидемия. Экспериментальная и клиническая гастроэнтерология. 2010; (3): 88–94. Samsonova N. G. , Zvenigorodskaya L. A. , CHerkashova E. A., Lazebnik L. B. Disbioz kishechnika i aterogennaya dislipidemiya. [Intestinal dysbiosis and atherogenic dyslipidemia]. Eksperimental’naya i klinicheskaya gastroenterologiya. 2010, no. 3. pp. 88–94.
8. Вахрушев Я.М., Лукашевич А. П., Горбунов А. Ю., Пенкина И. А. Интестинальные механизмы в нарушении энтерогепатической циркуляции желчных кислот при желчнокаменной болезни. Вестник РАМН. 2017; 72(2): 105–111. Vahrushev YA.M., Lukashevich A. P., Gorbunov A.YU., Penkina I. A. Intestinal’nye mekhanizmy v narushenii enterogepaticheskoj cirkulyacii zhelchnyh kislot pri zhelchnokamennoj bolezni. [Intestinal mechanisms in violation of enterohepatic circulation of bile acids in cholelithiasis]. Vestnik RAMN. 2017, vol. 72, no. 2, pp. 105–111.
9. Мирошниченко В. П. Громашевская Л. П. , Касаткина М. Г. Определение содержания желчных кислот и холестерина в желчи. Лабораторное дело. 1978, (3): 149–153. Miroshnichenko V. P. Gromashevskaya L. P. , Kasatkina M. G. Opredelenie soderzhaniya zhelchnyh kislot i holesterina v zhelchi. [Determination of the content of bile acids and cholesterol in bile]. Laboratornoe delo. 1978, no. 3, pp. 149–153.
10. Miyasaka K, Kanai S, Ohta M et аl. Susceptibility to obesity and gallbladder stasis produced by a protein- and fat-enriched diet in male mice compared with female mice // Nutr. Metab. (Lond). 2007.Vol. 4. P. 14.].
11. Вахрушев Я. М., Хохлачева Н. А., Сучкова Е. В., Пенкина И. А. Значение исследования физико-химических свойств желчи в ранней диагностике желчнокаменной болезни. Архивъ внутренней медицины. 2014;(6):48–51. DOI: 10.20514/2226–6704–2014–0–6–48–51 Vahrushev YA. M., Hohlacheva N. A., Suchkova E. V., Penkina I. A. Znachenie issledovaniya fiziko-himicheskih svojstv zhelchi v rannej diagnostike zhelchnokamennoj bolezni. [The importance of studying the physical and chemical properties of bile in the early diagnosis of gallstone disease]. Arhiv” vnutrennej mediciny. 2014, no. 6, pp. 48–51. DOI: 10.20514/2226–6704–2014–0–6–48–51
12. Гирса В.Н., Николаева А. Г., Немцов Л. М. Возможности коррекции дисмоторики желчного пузыря с помощью вегетотропной и адаптационной терапии. Материалы VII съезда НОГР, посвященного 40-летию Всесоюзного НИИ гастроэнтерологии. М.: Анахарсис; 2007: 211–212 Girsa V. N., Nikolaeva A. G., Nemcov L. M. Vozmozhnosti korrekcii dismotoriki zhelchnogo puzyrya s pomoshch’yu vegetotropnoj i adaptacionnoj terapii. [Correction of dimotika gallbladder with the help of wegetotropona and adaptive therapy]. Materialy VII s”ezda NOGR, posvyashchennogo 40-letiyu Vsesoyuznogo NII gastroenterologii. M.: Anaharsis; 2007: 211–212
Review
For citations:
Glazyrina N.N., Khokhlacheva N.A., Mikhailova O.D., Belova E.V. The combined application of Ursodeoxycholic acid (UDCA) and probiotic complex ProbioLog may affect lithogenesis processes in the early stages of gallstone disease in elderly people. Experimental and Clinical Gastroenterology. 2020;(9):29-34. (In Russ.) https://doi.org/10.31146/1682-8658-ecg-181-9-29-34