How is biliary dyskinesia treated?

Treatment of biliary dyskinesia in children has one goal - restoration of functional disorders of the biliary tract.

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Non-drug treatment of biliary dyskinesia in children

In case of dysfunction with increased sphincter tone, a complete diet with normal protein content, maximum restriction of fats (primarily refractory - lamb, goose, internal) and products that increase fermentation and putrefaction processes in the intestines (whole fresh milk, pastry, canned food, etc.) is prescribed. Products with a high content of vitamins A, C, group B, as well as plant fiber and liquid, which promotes the outflow of bile and bowel movement, are necessary. Food should be taken in small portions 5-6 times a day.

Exclude meat, mushroom and fish broths, green cabbage soup, fatty meats and fish, animal fats, fried foods, including pancakes and crepes, freshly baked bread, pastry and puff pastry products, egg yolks, canned goods, sausages, smoked meats, mustard, pepper, horseradish, vinegar essence of any concentration, onions, garlic, sorrel, radishes, peas, mushrooms, cocoa, chocolate, ice cream, sour fruits and berries.

Gray, coarse, rye dried bread, not sweet, sugar cookies are recommended. Soups should be cooked in vegetable broth, any vegetables, cereals, pasta, fruit soups are allowed. Lean meats and poultry are desirable boiled, baked with preliminary boiling, stewed with the removal of juice, lean fish (cod, pike perch, perch, navaga, pike, etc.) boiled or baked. Protein omelet can be cooked once a week from 1 egg. Sour cream in dishes, low-fat cottage cheese in natural or baked form, cheeses up to 30% fat, one-day low-fat fermented milk products (kefir, yogurt, etc.) are shown. Vegetables are allowed raw, boiled, baked; onions should be boiled before adding to dishes. All fruits are allowed, except sour ones. Recommended drinks include rosehip infusion, non-acidic juices diluted half and half with water, tea with milk or lemon, coffee with milk, dried fruit compotes. You cannot eat very cold or very hot food.

In case of hypomotor disorders, the child's diet should include vegetables and fruits rich in dietary fiber (dried apricots, strawberries, raspberries, oatmeal, dried rose hips, etc.), which reduce cholesterol and triglyceride levels and bile lithogenicity. Wheat bran, rich in magnesium salts, is recommended, as well as buckwheat, oatmeal, and seaweed. The American Dietetic Association recommends calculating dietary fiber intake by adding 5 to the child's age. For example, a 4-year-old child should receive 9 g of dietary fiber, and a 17-year-old child should receive 22 g.

The diet should be enriched with refined vegetable oils added to ready meals after cooking. Corn, olive, flaxseed, soybean, and peanut oils are used. Protein lipotropic products (cottage cheese, fish, egg whites, lean meat) have a good choleretic effect.

Food is served boiled or baked, chopping is not necessary. The temperature of the prepared dishes is normal, the number of meals is 5-6 times a day.

Drug treatment of biliary dyskinesia in children

Antispasmodics are considered to be the main drugs for the relief and prevention of attacks of acute abdominal pain in biliary tract dysfunctions. It is advisable to use drugs with rapid achievement of maximum concentration in serum, for example, fast-acting nitrates sublingually, anticholinergics and phosphodiesterase type I inhibitors for parenteral administration.

Fast-acting nitrates (nitroglycerin) are most effective for relieving severe pain attacks. The drug is given sublingually at a dose of 2.5-5 mg at the age of 7-12 years; 5-10 mg once a day for a child over 12 years. Platyfillin is prescribed orally or subcutaneously 1 mg at the age of 5 years; 2 mg - at 10 years; 3-4 mg for a child over 12 years. Hyoscine butylbromide is administered intramuscularly or intravenously at 10-20 mg for children over 12 years. Myotropic antispasmodics (drotaverine) are prescribed intramuscularly at 0.5 ml of a 2% solution 2-3 times a day at 5 years; 1 ml - for a child of 10 years; 1.5-2 ml - from 15 years. Antispasmodics of plant origin (cholagol 5-20 drops in sugar or chophytol 1 tablet orally) are indicated for attacks of hypertonic dyskinesia.

In case of severe, long-term intractable pain, treatment of biliary dyskinesia is based on the use of narcotic analgesics, such as promedol, intramuscularly 0.25 ml of a 1% solution at the age of 5 years; 0.5 ml - at 10 years; 0.75-1.0 ml for a child of 15 years 1-2 times a day. It is necessary to avoid the use of codeine and morphine-like drugs.

To prevent the development of attacks, one of the phosphodiesterase type IV inhibitors, sodium and calcium channel blockers is used orally in courses for 1-2 months:

• drotaverine orally 0.01 mg (for a 5-year-old child) 3-4 times a day; 0.02 mg (10 years) 3-4 times a day or 0.03-0.04 mg (15 years) 3-4 times a day;
• papaverine orally or rectally 5 mg (for children from 6 months to 2 years); 5-10 mg (3-4 years); 10 mg (5-6 years); 10-15 mg (7-9 years) 15-20 mg (10-14 years) 3-4 times a day;
• otilonium bromide orally 1/2 tablet of 40 mg (for a child 5 years old) or 1 tablet (10 years and older) 2-3 times a day;
• mebeverine orally 50 mg (from 6 years); 100 mg (9-10 years), 150 mg (over 10 years) 20 minutes before meals 2 times a day;
• Hymecromone for children over 12 years of age orally 200-400 mg 3 times a day.

The action of hymecromone resembles the biological effects of cholecystokinin.

The drug has a selective antispasmodic effect on the sphincter of Oddi and the sphincter of the gallbladder, ensures the outflow of bile into the duodenum, reduces pressure in the biliary system, and has virtually no effect on smooth muscle cells of other localizations. Medicines that eliminate hypertonicity of the gallbladder:

• platifillin orally 0.001 g (5 years), 0.002 g (10 years), 0.003 g (15 years) 2-3 times a day before meals;
• hymecromone 0.1 g - 1/2 tablet (5-10 years), 0.2 g - 1 tablet (15 years) 3 times a day 30 minutes before meals for 2 weeks.

To stimulate bile formation, true choleretics are used, in particular, medications containing bile or bile acids:

• holenzim orally 1/2 tablet (for children 5-10 years old) or 1 tablet (15 years old) after meals 3 times a day for 2 weeks;
• Allochol - children under 7 years old 1 tablet, over 7 years old - 2 tablets 3 times a day for 3-4 weeks. Synthetic drugs:
• tsikvalon orally 1/2 tablet (for children 5-10 years old) or 1 tablet (15 years old) after meals for 2 weeks;
• oxafenamide orally 1/2 tablet (for children 5-10 years old) or 1 tablet (15 years old) before meals 3 times a day for 2 weeks.

Choleretic preparations of plant origin are widely used:

• flamin orally 1/2 tablet (for a child 5-10 years old) or 1 tablet (15 years old) 30 minutes before meals for 2 weeks;
• hepabene orally, 1 capsule 3 times a day during meals for 2 weeks;
• chophytol orally, 1 tablet (for children 5-10 years old) or 2 tablets (15 years old) 3 times a day before meals for 2 weeks;
• Olimethin 1-2 capsules 3 times a day before meals for 3 weeks.

To increase the secretion of bile and reduce its viscosity, as well as to stimulate blood and lymph circulation in the liver, mineral waters of medium mineralization are prescribed (Essentuki No. 4 orally 3 ml/kg 30 minutes before meals for 1 month) or hydrocholeretics:

• magnesium sulfate 20% solution, 1/2 tablespoon 2-3 times a day;
• xylitol 5 g 2 times a day after meals for 2 weeks;
• sorbitol 2.5 g (for children 5-10 years old); 5 g (15 years old) 2 times a day 30 minutes before meals for 2 weeks.

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Physiotherapy

In the hyperkinetic form of gallbladder dyskinesia, electrophoresis with procaine, paraffin applications, radon and pine baths are prescribed. In hypokinetic disorders, electrophoresis with magnesium sulfate, faradization, galvanization, Bernard's diadynamic currents, massage of the cervical-collar region, mud applications to the right hypochondrium are indicated.

Sanatorium and resort treatment of biliary dyskinesia in children

Sanatorium and spa treatment is widely used for cholepathies in children. Treatment with mineral waters is used (balneotherapy-crenotherapy, hydrotherapy, water therapy in the form of showers, baths, etc.).

Indications: cholangitis, cholecystitis outside of exacerbation; biliary dyskinesia.

Contraindications:

• cholelithiasis in the presence of frequent and prolonged severe attacks with impaired bile outflow and signs of active infection;
• liver failure;
• fever;
• exacerbation of the inflammatory process in the stomach or intestines;
• chronic renal failure;
• the child's serious condition.

When prescribing mineral water, it is necessary to pay attention to the following factors: total mineralization of water (the sum of all substances dissolved in water should be at least 2 g/l), ionic composition of water (hydrocarbonate, chloride, sulfate, sodium, calcium, magnesium, combined waters), content of biologically active components (iron, cobalt, copper, manganese, iodine, bromine, fluorine, silicon). Most often, for medicinal purposes, hydrocarbonate, hydrocarbonate-chloride, hydrocarbonate-sulfate waters of low (2-5 g/l) or medium (5-15 g/l) mineralization are used for oral administration (Borjomi, Essentuki 4 and 17, Arzni, Jermuk, Slavyanovskaya, Smirnovskaya, etc.). Depending on the degree of mineralization, water can be hypo-, iso- and hypertonic. Hypo- and isotonic waters have a diuretic effect; Hypertonic waters are poorly absorbed and have a laxative effect. The nature of mineral water depends on pH (pH of alkaline waters is above 8.5; acidic - 5.5; neutral - 6.8-7.2). Mineral water taken warm has a stimulating secretion effect. Cold waters stimulate the motor function of the stomach, are quickly evacuated, are poorly absorbed, and have a laxative effect. Low-mineralization water has a bile-secreting effect, while highly mineralized water has a choleretic effect. The combination of sulfate and magnesium in water increases the release of bile from the bladder, while relaxing the sphincter of Oddi. When mineral water is taken orally, the gallbladder contracts, peristalsis of the bile ducts increases, which helps empty the gallbladder, reducing bile stagnation and the tendency to form stones. Hydrocarbonate water reduces the viscosity of bile and inflammation in the gallbladder. Mineral water is dosed at a rate of 3-5 ml/kg per dose or as follows:

• children aged 6-8 years - 50-100 ml;
• at the age of 9-14 years - 120-150 ml;
• over 12 years old - 150-200 ml per dose.

Usually, water intake is prescribed 3 times a day. In the first 5-6 days, to avoid a sharp choleretic effect, water is used in half the dose. It is taken warmed to 36-42 °C 1 hour before meals for 4-6 months. Mineral water can be used for tubage to improve bile outflow.

Radon baths are not used for children.

Complications and side effects in the treatment of biliary dyskinesia

Some medications may have unwanted effects or cause side effects.

• Cholenzym is contraindicated in patients with hypersensitivity to cow's milk proteins.
• Oxafenamide is not used in degenerative processes in the liver.
• Gepabene has a laxative effect.
• Platyphylline is not prescribed for kidney dysfunction.
• Papaverine is contraindicated in atrioventricular conduction disorders.
• Hymecromone is not used for peptic ulcer and hemolytic anemia.

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Outpatient observation

The duration of dispensary observation is not less than 2 years. Courses of choleretic therapy twice a year, balneotherapy, health improvement in specialized sanatoriums, control ultrasound of the biliary tract once a year are indicated.

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What is the prognosis for biliary dyskinesia?

With a correctly specified type of dysfunction, the prognosis is favorable. Adequate treatment of biliary dyskinesia leads to complete normalization of existing disorders.