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Dissolution of gallstones with drugs
Last reviewed: 23.04.2024
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It is believed that the dissolution of gallstones with the removal of cholesterol, which is part of gallstones, as a result of the use of bile acid preparations occurs by micellar dilution, the formation of a liquid crystalline form or both.
Micellar dilution appears to be the main mechanism of dissolution of gallstones with preparations of chenodeoxycholic acid, whereas the formation of a liquid crystalline phase plays an important role in the use of ursodeoxycholic acid preparations.
The rate of dissolution of gallstones largely depends on the content of bile acids, the ratio of the surface to the volume of calculi (therefore, multiple small stones dissolve more quickly) and from the movement of bile, i.e. The rate of gallbladder emptying (kinetic factor).
During dissolution, a non-dissolving material can gradually accumulate on the surface of the stones, which slows the dissolution process. In these cases, some authors consider the additional use of lithotripsy expedient.
Dissolution of gallstones with ursodeoxycholic acid
To date, clear indications and criteria for selecting patients for litholitic therapy with ursodeoxycholic acid (UDCA, URSOSAN) have been developed, compliance with which increases its effectiveness to 80-100%. It should be noted that no more than 20% of all patients with cholelithiasis satisfy these criteria. The main conditions for successful dissolution of gallstones:
- Cholesterol (X-ray negative stones);
- size of stones no more than 10 mm;
- patency of extrahepatic biliary tract and preserved or little-changed function of the gallbladder (concentration and contractile);
- The gallbladder is filled with concrements no more than 25% of its volume on an empty stomach.
These conditions require mandatory clarification with ultrasound:
- Homogeneous, low echo structure of the calculus (in the presence of an acoustic shade from the front surface of the stone or above its center, litholytic therapy is not shown).
- Round or oval shape of the calculus (patients with pyramidal or flat configuration of stones are excluded).
- The surface of the stone is close to flat or in the form of a "mulberry berry".
- A non-intense, poorly noticeable acoustic shadow behind the stone,
- Slow falling of the stone after the patient's position change
- The size of the stone is no more than 10 mm.
[8], [9], [10], [11], [12], [13], [14]
Dissolution of gallstones by ursosan
One of the most effective modern drugs for litholytic therapy is URSOSAN (UDCA). We give the scheme of its application: The average dosage of the drug for the dissolution of gallstones is 10 mg / kg of body weight. Usually the daily dose of the drug is taken once in the evening, which is associated with the daily rhythm of cholesterol synthesis, the peak occurs at night, and also with the period of maximum functional dormancy of the gallbladder. Duration of the drug until complete dissolution of the stones and at least three more months to prevent the recurrence of stone formation. Thus, the total duration of treatment is 6-12 months or more.
It is believed that the absence of reduction in the size of the stones for 6 months, as well as their complete dissolution during 2 years, is the basis for stopping litholytic therapy.
With successfully conducted and completed treatment there should not be calmness of the doctor and patient, as 10% of patients have a chance of relapse during the first year, therefore, for prevention of relapse, such patients should undergo ultrasound twice a year. Meanwhile, it is well known that a decrease in the size and quantity of concrements considered an indicator of effectiveness depends not only on the dissolving effect of the drugs, but also on the experience of an ultrasound specialist evaluating the effectiveness of therapy, the type of apparatus, the position of the patient at the time of the study, etc. Despite the fact that litholytic therapy is costly, the dissolution of gallstones with drugs allows you to maintain a functioning gallbladder.