Biliary dyskinesia: traditional and modern views

Abstract

Traditional and modern views on pathogenesis, clinical manifestations, diagnosis and treatment of the gallbladder and biliary sphincters dysfunctions are analyzed in the article. Functions of bile and its role in the process of digestion are highlighted. Diagnostic criteria for biliary dysfunctions are described in detail in accordance with the Rome Consensus IV (mandatory and confirmatory); clinical and diagnostic criteria for the classical variants of biliary dyskinesia, namely hypo- and hyperkinetic dyskinesia of the gallbladder, are being presented. Treatment of biliary dysfunctions is described according to the Rome Consensus IV, taking into account the type of dyskinesia. It is reasonable to follow the basic principles of dietary nutrition in diseases of the biliary tract, as well as to protect the mucous membrane of the upper gastrointestinal tract from mechanical, thermal and chemical effects. It is important to eat in a relaxed atmosphere, not in a hurry. The antispasmodics that are used for biliary dysfunctions are listed: M-cholinolytics, myotropic antispasmodics, calcium and sodium channel blockers, etc. Importance of ursodeoxycholic acid in treatment of functional biliary diseases is emphasized. The use of ursodeoxycholic acid preparations in biliary dyskinesia is based on its ability to reduce the lithogenicity of bile, as well as exert an anti-inflammatory effect on the mucous and muscular layer of the biliary tract, which indirectly contributes to the normalization of impaired motility and secretion. Advantages of the combined drug Engilen consisting of milk thistle, artichoke and turmeric are highlighted. With the ineffectiveness of conservative treatment and the results of the examination, confirming structural changes (stenosis) in the ending area of common bile and/or pancreatic duct, decision on endoscopic treatment can be made.