Possibilities of modern pharmacotherapy in patients with dysfunction of the sphincter of Oddi

Abstract

Pain  in the  right  hypochondrium is one  of the  most  frequent  complaints  in patients with  diseases  of the  biliary system. According to statistics, every tenth  person experiences unpleasant sensations in the upper right abdomen  after drinking alcohol, fatty, fried or salty food, as well as after  psychoemotional and physical exertion. The most  common  of the  pathologies of the  biliary system  is the  sphincter  of Oddi dysfunction  (SOD). SOD is a clinical syndrome  caused  by a functional  disorder of sphincter  of Oddi (SO), which leads  to the  development of abdominal  pain syndrome, increased activity of liver and / or pancreatic enzymes, dilatation of the common bile duct and the main pancreatic duct. One of the methods of treatment of SOD is drug  therapy,  accompanied by the  following  groups  of drugs:  antispasmodics, nitrates,  choleretics,  antidepressants, etc. At the  same  time, many medications show low efficacy against  SOD, or cause  pronounced side  effects. At present,  for the treatment of sphincter  of Oddi dysfunction,  the  domestic  drug  from the  group  of myotropic  antispasmodics, hymecromon, Holicron, has the optimal  characteristics in terms  of price-quality  ratio in the Russian pharmacological market. The drug has a selective  antispasmodic effect  on SO, and also has a choleretic effect. Mechanism  of antispasmodic action  is an increase in the concentration of nitric oxide (II) and cyclic mononucleotides, which through  a cascade  of biochemical  reactions  leads to a decrease in the number of calcium ions in the cell and a decrease in the tone of smooth  myocytes of SO and gallbladder. The drug is absorbed  into the blood in a small amount, which excludes  its systemic effect and determines the selectivity of the effect on the biliary system. According to the results  of clinical testing  and consideration of a specific clinical case, it can be concluded that  the use of hymecromone (Holicron) reduces  the severity of pain syndrome  and reduces  dyspepsia  syndrome, good tolerability  and absence of side effects that  would require withdrawal  of the drug are also recorded.