DOI: https://doi.org/10.22141/2224-0551.13.0.2018.131177

Experience of using ursodeoxycholic acid in the therapy of biliary sludge in children

O.Yu. Belousova, L.G. Voloshyna, O.B. Hanzii, O.M. Вabadzhanian, O.L. Slobodianiuk

Abstract


Background. The article presents the causes, diagnostic criteria and peculiarities of pathogenetic therapy of biliary sludge (BS). The results of the study on the effectiveness of Ukrliv (ursodeoxycholic acid) are described in the correction of sludge syndrome in children. Materials and methods. Open comparative study included 60 patients with BS (42 girls, 18 boys) aged 4 months to 8 years. BS diagnosis in each child was established during ultrasound examination of the abdominal cavity. After this, two groups of 30 persons were formed by means of random sampling: study group — Ukrliv was used at a dose of 10 mg/kg body weight once a day in the evening for a month on the background of standard therapy; comparison group — children received only standard therapy. Before treatment and after it, we have evaluated clinical manifestations of the disease, the data of ultrasound examination of the abdominal cavity, the results of the biochemical study of the liver function. Results. In the study group, on the background of Ukrliv administration, BS was resolved or decreased in all children, while only 8 of the 30 children in the comparison group had spontaneous disappearance of BS. In the comparison group, the results of the biochemical study of the liver function were a little different from baseline and significantly different from indicators of the study group, where normalization of the biochemical liver functions occurred. Conclusions. Ukrliv administration contributed to the rapid resolution of BS according to ultrasound research. On the background of drug intake, there was a rapid normalization of liver function. Ukrliv did not cause side effects that would require drug withdrawal, and was well tolerated by sick children. Inclusion of Ukrliv (ursodeoxycholic acid) in the comprehensive therapy of children with BS is pathogenetically grounded.


Keywords


biliary sludge; ursodeoxycholic acid; Ukrliv

References


Chogle A, Velasco-Benitez CA, Koppen IJ, Moreno JE, Ramírez Hernández CR, Saps M. A 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.

Lewis ML, Palsson OS, Whitehead WE, van Tilburg MAL. Prevalence of functional gastrointestinal disorders in children and adolescents. J Pediatr. 2016 Oct;177:39-43.e3. doi: 10.1016/j.jpeds.2016.04.008.

Cotton PB, Elta GrH, Carter CR, Pasricha PJ, Corazziari ES. Gallbladder and Sphincter of Oddi Disorders. Gastroenterology. 2016 May;150(6):1420-1429.e2. doi: 10.1053/j.gastro.2016.02.033.

Ko CW, Lee SP. Biliary sludge and cholecystitis. Best Pract Res Clin Gastroenterol. 2003 Jun;17(3):383-96. doi: 10.1016/S1521-6918(03)00026-X.

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.

Jüngst C, Kullak-Ublick GA, Jüngst D. Gallstone disease: Microlithiasis and sludge. Best Pract Res Clin Gastroenterol. 2006;20(6):1053-62. doi: 10.1016/j.bpg.2006.03.007.

Mahida JB, Sulkowski JP, Cooper JN, et al. Prediction of symptom improvement in children with biliary dyskinesia. J Surg Res. 2015 Oct;198(2):393-9. doi: 10.1016/j.jss.2015.03.056.

Kalra S, Kalra B, Thakur A, Sharma A. Biliary sludge and recurrent ketoacidosis: a case report. Diabetol Metab Syndr. 2009 Dec 22;1:28. doi: 10.1186/1758-5996-1-28.

Costa S, Barone G, Catenazzi P, Romagnoli C. Parenteral nutrition associated cholestasis. Italian Journal of Pediatrics. 2015;41(Suppl 1):A4. doi: 10.1186/1824-7288-41-S1-A4.

European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Management of cholestatic liver diseases. J Hepatol. 2009 Aug;51(2):237-67. doi: 10.1016/j.jhep.2009.04.009.

Herzog D, Bouchard G. High rate of complicated idiopathic gallstone disease in pediatric patients of a North American tertiary care center. World J Gastroenterol. 2008 Mar 14;14(10):1544-8. doi:10.3748/wjg.14.1544.

Brumbaugh D, Mack C. Conjugated hyperbilirubinemia in Children. Pediatr Rev. 2012 Jul;33(7):291-302. doi: 10.1542/pir.33-7-291.

Zavhorodnya NYu, Lukianenko OYu, Yahmur VB, Konenko IS. Gallbladder function and hepatic structural changes in children with nonalcoholic fatty liver disease. Gastroenterologia. 2016;(60):38-43. doi: 10.22141/2308-2097.2.60.2016.74731. (in Ukrainian).

Shiu TY, Huang HH, Lin HH, et al.  Restriction fragment length polymorphism effectively identifies exon 1 mutation of UGT1A1 gene in patients with Gilbert’s Syndrome. Liver Int. 2015 Aug;35(8):2050-6. doi: 10.1111/liv.12785.

Nobili V, Alisi A, Raponi M. Pediatric non-alcoholic fatty liver disease: Preventive and therapeutic value of lifestyle intervention. World J Gastroenterol. 2009 Dec 28;15(48):6017-22. doi:10.3748/wjg.15.6017.

Pacifico L, Anania C, Martino F, et al. Management of metabolic syndrome in children and adolescents. Nutr Metab Cardiovasc Dis. 2011 Jun;21(6):455-66. doi: 10.1016/j.numecd.2011.01.011.

Вabadzhanian OM, Shutova OV, Voloshyna LG, Hanzii OB, Kaafarani A, SlobodianiukOL. Gilbert’s syndrome targeted therapy. Zdorov’e rebenka. 2017;12(2.1):219-224. doi: 10.22141/2224-0551.12.2.1.2017.100984. (in Ukrainian).

Santos JL, Choquette M, Bezerra JA. Cholestatic Liver Disease in Children. Curr Gastroenterol Rep. 2010 Feb;12(1):30-9. doi: 10.1007/s11894-009-0081-8.

Mehta S, Lopez ME, Chumpitazi BP, Mazziotti MV, Brandt ML, Fishman DS. Clinical Characteristics and Risk Factors for Symptomatic Pediatric Gallbladder Disease. Pediatrics. 2012 Jan;129(1):e82-8. doi: 10.1542/peds.2011-0579.

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.

Shutova EV, Belousova OYu, Pavlenko NV. Optimization of diagnosis of early stage of gallstone disease in children. Sovremennaya pediatriya. 2015;2(66):88-91. doi 10.15574/SP.2015.65.88.

Paumgartner G, Beuers U. Ursodeoxycholic Acid in Cholestatic Liver Disease: Mechanisms of Action and Therapeutic Use Revisited. Hepatology. 2002 Sep;36(3):525-31. doi: 10.1053/jhep.2002.36088.

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.

Ikegami T, Matsuzaki Y. Ursodeoxycholic acid: Mechanism of action and novel clinical applications. Hepatol Res. 2008;38(2):123-31. doi: 10.1111/j.1872-034X.2007.00297.x.

Kumar D, Tandon RK. Use of ursodeoxycholic acid in liver diseases. J Gastroenterol Hepatol. 2001 Jan;16(1):3-14. doi: 10.1046/j.1440-1746.2001.02376.x.

Pusl T, Beuers U. Ursodeoxycholic acid treatment of vanishing bile duct syndromes. World J Gastroenterol. 2006 Jun 14;12(22):3487-95. doi: 10.3748/wjg.v12.i22.3487.

Cheng K, Ashby D, Smyth RL. Ursodeoxycholic acid for cystic fibrosis-related liver disease. Cochrane Database Syst Rev. 2017 Sep 11;9:CD000222. doi: 10.1002/14651858.CD000222.pub4.

Gamboa A, Tian C, Massaad J, Reshamwala P, Cai Q. The Therapeutic Role of Ursodeoxycholic Acid in Digestive Diseases. Ann Gastroenterol Hepatol. 2011;1(2):43-49.

Wang JY, Wu SD. Chapter 55: Ursodeoxycholic Acid for the Treatment of Liver Diseases. In: Muriel P, editor. Liver Pathophysiology. UK, London: Academic Press is an imprint of Elsevier; 2017. 767-779 pp. doi: 10.1016/B978-0-12-804274-8.00055-2.




Copyright (c) 2018 CHILD`S HEALTH

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

 

© Publishing House Zaslavsky, 1997-2018

 

   Seo анализ сайта