Comparative effectiveness of ursodeoxycholic acid preparations in the treatment of biliary sludge

Abstract

In the clinical classification of cholelithiasis, biliary sludge (BS) is distinguished as the pre-stone stage. Ursodeoxycholic acid (UDCA) is a drug with an evidence base for effective and safe effects on BS. The therapeutic equivalence of various UDCA drugs remains an important issue for clinical practice.
 Aim. To conduct a comparative analysis of the effectiveness of the use of UDCA: Ursofalk with other UDCA drugs for the treatment of BS in a fixed dose of 10 mg/kg of body weight.
 Material and methods. The observation group consisted of 225 patients with various types of BS. In randomized groups, the comparison of the effectiveness of UDCA drugs in the dissolution of BS was determined by the data of ultrasound of the gallbladder. Dynamic ultrasound cholecystography using a standardized technique was performed to study the effect of the compared drugs on the contractile function of the liver. When analyzing the impact of ursotherapy on the clinical manifestations of BS, the dynamics of biliary pain syndrome and dyspeptic disorders were evaluated.
 Results. A comparative analysis of the effectiveness of UDCA drugs for BS lysis with a high degree of confidence established the advantage of Ursofalk: after 3 months in 80%, and after 6 months of therapy in 95.65% of patients, a regression of BS was detected. In the group of patients who took other UDCA, the corresponding indicators were 46.36% and 67.27%. The greatest effectiveness of ursotherapy was demonstrated in the BS variant by the type of suspension of hyperechogenic particles, the lowest in the variant by the type of putty-like bile in the form of mobile or fixed clots. In the last variant of BS, the relationship between the success of lysis with the extension of the UDCA intake period to 6 months and the preferred choice of Ursofalk was traced. Normalization of the contractile function of the gallbladder was noted in patients who took Ursofalk.
 Conclusion. From the standpoint of therapeutic effectiveness, the drug of choice for the treatment of BS, regardless of its type, is Ursofalk, which has proven the best dynamics of BS litolysis, recovery of the contractile function of the gastrointestinal tract, and relief of clinical symptoms.

Severe Tropical Malaria with Acute Kidney Injury: A Case in a Remote Area

“…Ursodeoxycholic acid (UDCA) orally twice a day was given. UDCA has been proven as effective and safe for biliary sludge treatment 16 and may be beneficial as an adjunctive therapy for malaria-related jaundice, although Treepasertsuk (2009) study did not show statistically significant improvement in liver test result compared to placebo. 17 Jaundice can be accompanied by increase in liver enzymes (3-8 times), although rarely reach the level of acute hepatitis.…”

“…Most patients benefited from amitriptyline. 16 Cushman et al discovered that patients taking either gabapentin or amitriptyline improved compared to those who did not receive treatment. 10 On examination, the patient appeared moderately ill with full consciousness (CGS E4V5M6), blood pressure of 100/60 mmHg, heart rate of 96 beats per minute, respiratory rate of 20/per minute with oxygen saturation of 99%, and body temperature of 38.8 o C. Anemic conjunctiva and icteric sclera were observed.…”

“…Most patients benefited from amitriptyline. 16 Cushman et al discovered that patients taking either gabapentin or amitriptyline improved compared to those who did not receive treatment. 10 For a quick early diagnosis, a Rapid Diagnostic Test (RDT) device can be used in emergency conditions, during malaria outbreaks, and in healthcare facilities with limited microscopic examination and malaria screening capabilities.…”

“…Most patients benefited from amitriptyline. 16 Cushman et al discovered that patients taking either gabapentin or amitriptyline improved compared to those who did not receive treatment. 10 falciparum parasites accompanied by jaundice and acute kidney injury in this case were signs of severe malaria.…”