Modern approaches to treatment of patients with biliary sludge: how to choose optimal scheme?

Abstract

Currently, biliary sludge (BS) is considered as a pathological process associated with an increase in the lithogenicity of bile and according to the modern classification of gallstone disease referred to the prestone stage of the disease. In the mechanism of BS formation, the main role belongs to four factors: glut of bile with cholesterol, formation of crystallization nucleus, dysfunction of the gallbladder (contraction, absorption, secretion), violation of the enterohepatic circulation of bile acids. Clinical manifestations in BS are most often associated with concomitant functional disorders of the biliary tract and chronic bacterial duodenitis with duodenal hypertension. The main directions in the treatment of BS are reduced to the restoration of the normal rheological properties of bile, the normalization of the motor function of the biliary system and the duodenum, the correction of the intestinal microbiome. The article discusses effective treatment regimens for BS depending on its morphological features and clinical course with the use of ursodeoxycholic acid or hofitol. The mechanism of Chophytol action (Mayoly Spindler, France) at BS is presented. The additional use of Meteospasmyl in the presence of intestinal antiseptic indications contributes to the rapid resolution of clinical manifestations in this pathology.