Issues of therapy for biliary pathology in children: the choice of the optimal solution
Background. Diseases of the hepatobiliary system are one of the most important problems of pediatric gastroenterology. Lesions of the biliary tract are associated with persistent changes in lipid metabolism that contributes to the prolonged cholestasis and to the progression of the biliary pathology. The purpose of this study was to evaluate the efficacy and safety of Ursofalk® in the comprehensive therapy of biliary tract diseases and comorbid pathology in children. Materials and methods. The results of examination and integrated treatment of 55 children aged 5 to 18 years (31 girls and 24 boys) with diseases of the biliary tract and comorbid pathology were analyzed. The criteria for inclusion of patients in the study were: the presence of diseases of the biliary tract accompanied by biliary sludge and blood lipid disorders. Diagnostic complex included: analysis of clinical data, ultrasound examination of abdominal organs, biochemical blood analysis (liver tests, lipid disorders). Depending on the comorbid pathology, all children received comprehensive treatment within a month. Patients were divided into two groups depending on choleretic therapy: group 1 (main) received conventional cholagogues, group 2 (comparison) — Ursofalk®. Licensed software products (Statistica, Excel) were used for statistical processing of the obtained data. Results. By the end of the treatment with Ursofalk® we observed positive dynamics in patients’ condition and laboratory indicators. In patients who received Ursofalk®, the manifestations of pain syndrome and dyspepsia completely disappeared. Children from the comparison group still had pain syndrome, a feeling of heaviness in the right upper quadrant and dyspepsia. The use of Ursofalk® normalized the parameters of the bile structure and the biochemical parameters of lipid metabolism. We registered a significant (p < 0.05) decrease in the incidence of impaired bile homogeneity — by 65.5 % in children from the main group. In children of the comparison group, it decreased only by 27.3 %. Positive dynamics of biochemical parameters was observed in both groups of patients, but with significant changes (p < 0.05) in the group of children taking Ursofalk®. Conclusions. Ursodeoxycholic acid (UDCA) use is pathogenetic justified for the correction of functional and metabolic disorders in biliary and comorbid pathologies in children. Ursofalk® administration in the comprehensive therapy of the diseases of the biliary system in children led to the rapid regression and relief of clinical symptoms and the improvement of laboratory-instrumental indicators. Ursofalk® is a reference product of UDCA. Availability of the officinal form of Ursofalk® in a special form for children (suspension) allows UDCA to be used in childhood, starting from the first days of life.
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Вabadzhanian OM, Shutova OV, Voloshyna LG, Hanzii OB, Kaafarani A, Slobodianiuk OL. Gilbert’s syndrome targeted therapy. Zdorovʹe rebenka. 2017;12(2.1):219-24. doi: 10.22141/2224-05188.8.131.5217.100984. (in Ukrainian).
Berezenko VS, Myhailyuk HZ, Dyba MB, Tkalik OM. Causes, dignostics and strategies of treating fatty liver disease and nonalcoholic steatohepatitis in children. Sovremennaya pediatriya. 2014;(4):1-7. (in Ukrainian).
European Association for the Study of the Liver (EASL). EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones. J Hepatol. 2016 Jul;65(1):146-181. doi: 10.1016/j.jhep.2016.03.005.
Chogle A, Velasco-Benitez CA, Koppen IJ, Moreno JE, Ramírez Hernández CR, Saps M. Population-Based Study on the Epidemiology of Functional Gastrointestinal Disorders in Young Children. J Pediatr. 2016 Dec;179:139-143.e1. doi: 10.1016/j.jpeds.2016.08.095.
Lin OS, Kozarek RA, Arai A, et al.The association between cholecystectomy and gastroesophageal reflux symptoms: a prospective controlled study. Ann Surg. 2010 Jan;251(1):40-5. doi: 10.1097/SLA.0b013e3181b9eca4.
Belousova OYu, Pavlenko NV, Voloshin KV, Savytska KV, Hanzii OB, Slobodianiuk OL. Modern problems of treatment of Helicobacter-associated diseases in children: opportunities of adjuvant therapy. Zdorovʹe rebenka. 2017;12(2.1):239-48. doi: 10.22141/2224-05184.108.40.206.2017.100987. (in Ukrainian).
Shardrin OH, Ihnatko LV. Modern approaches to the diagnosis and treatment of gastroesophageal reflux disease in children. Zdorovia Ukrainy: Hatsroenterolohiia, hematolohiia, koloproktolohiia. 2016;(41):26-27.
Department of health and human service Food and Drug Administration Pediatric Gastroesophageal Reflux Disease: Developing Drugs for Treatment Guidance for Industry. Federal Register. 2017;82(207): 49837-49838.
Nassr AO, Gilani SN, Atie M, et al. Does impaired gallbladder function contribute to the development of Barrett's esophagus and esophageal adenocarcinoma? J Gastrointest Surg. 2011 Jun;15(6):908-14. doi: 10.1007/s11605-011-1520-z.
Ministry of Health of Ukraine. Order No 59, dated 29 Jan 2013: On approval of unified clinical protocols of medical care for children with diseases of the digestive system. Available from: http://old.moz.gov.ua/ua/portal/dn_20130129_0059.html. Accessed: April 03, 2018.
Nissinen MJ, Pakarinen MP, Gylling H, Koivusalo A. Cholesterol and non-cholesterol sterols in serum and gallstones interfere with pathogenesis of pediatric gallstone disease: poster [abstract no. 1310]. In: Abstracts of the 64th Annual Meeting of the American Association for the Study of Liver Diseases: the Liver Meeting 2013. November 1-2, 2013. Washington, D.C., USA. Hepatology. 2013 Oct;58 Suppl 1:844A. doi: 10.1002/hep.26791.
Guarino MP, Cocca S, Altomare A, Emerenziani S, Cicala M. Ursodeoxycholic acid therapy in gallbladder disease, a story not yet completed. World J Gastroenterol. 2013 Aug 21;19(31):5029-34. doi: 10.3748/wjg.v19.i31.5029.
Zavhorodnia NYu, Lukianenko OYu, Babiy SO, Kudryavtseva VE, Petishko OP. The role of systemic inflammation in the pathogenesis and progression of nonalcoholic fatty liver disease in children. Child’s Health. 2017;12(2.1.):232-8. doi: 10.22141/2224-05220.127.116.1117.100986. (in Ukrainian).
Rahilly-Tierney CR, Arnett DK, North KE, et al. Apolipoprotein ε4 polymorphism does not modify the association between body mass index and high-density lipoprotein cholesterol: a cross-sectional cohort study. Lipids Health Dis. 2011 Sep 23;10:167. doi: 10.1186/1476-511X-10-167.
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