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Introduction. Statistical data indicate a frequent combination of functional biliary disorders with non-alcoholic fatty liver disease.Aim. To study the efficacy and safety of Phosphogliv® URSO in patients with functional disorders of the gall-bladder, biliary sludge in combination with fatty hepatosis in comparison with the group receiving monotherapy ursodeoxycholic acid (UDCA).Materials and methods. The study included 30 patients with a diagnosis of functional gall-bladder disorder, biliary sludge in combination with non-alcoholic fatty liver disease. Patients of the main group received monotherapy with Phosphogliv® URSO. The comparison group received monotherapy UDCA. After three-month therapy, the dynamics of clinical symptoms, laboratory parameters, and ultrasound parameters were assessed.Results. Positive dynamics of clinical manifestations of functional disorders of the gallbladder, as well as parameters of cholestatic syndrome and bilirubin level was observed in both groups. In patients taking Phosphogliv® URSO, a significant decrease in cytolysis syndrome indicators was recorded, a significant difference was revealed in relation to an increase in HDL levels and a decrease in the atherogenic coefficient in the main group. When assessing the ultrasound parameters of the gall-bladder in patients of group 1, a significant decrease in the thickness of its wall, reverse development of biliary sludge, an improvement in the contractile function of the gall-bladder in comparison with the UDCA monotherapy group were revealed.Conclusion. The use of a combined medicine containing glycyrrhizic acid and UDCA (Phosphogliv® URSO) can be recommended for patients with functional disorders of the gallbladder, biliary sludge and non-alcoholic fatty liver disease, given its more pronounced anticytolytic effect, restoration of functional disorders of the gallbladder and resolution of biliary sludge in comparison with monotherapy UDCA.

Introduction. The prevalence of functional biliary disorders continues to increase with insufficient effectiveness of existing treatment approaches. Among them, functional biliary disorders of sphincter of Oddi account for at least 50%.Objective. To study efficacy, safety and tolerability of a fixed combination of glycyrrhizic acid and ursodeoxycholic acid (Fosfogliv Urso) in capsule form in patients with functional biliary disorders of sphincter of Oddi.Materials and Methods. The study included 32 patients diagnosed with functional biliary sphincter of Oddi disorders established according to the Rome Criteria IV revision (2016). Patients received Fosfogliv Urso (250 mg ursodeoxycholic acid and 35 mg glycyrrhizic acid) 1 capsule 3 times a day for 8 weeks. Prior to treatment, all study participants underwent a standard set of laboratory and instrumental examinations.Results. Against the background of Fosfogliv Urso treatment, statistically significant decrease of biliary pain prevalence up to 48.3% (p < 0.001); intense biliary pain up to 11.4% (p < 0.0001); intensity of pain syndrome on visual analogue scale down to 1.7 ± 0.9 cm was registered (p < 0.0001). Alanine aminotransferase activity significantly decreased to 34.0 ± 4.0 U/L (p < 0.001). There was a tendency of choledochal diameter decrease to 0.57 ± 0.01 cm. Treatment efficacy was rated by patients as very good and good in 83.4% of cases. The safety profile was assessed as favorable and tolerability as satisfactory.Discussion. The results obtained were superior to those previously obtained for ursodeoxycholic acid monotherapy and confirmed the data of the previously conducted phase III study. The rationality of the combination is due to the mutual complementation and possible synergism of the pharmacological effects of glycyrrhizinic and ursodeoxycholic acids.Conclusion. The results obtained allow to recommend the prescription of Fosfogliv Urso in the complex scheme of treatment and prophylaxis of functional biliary disorders of sphincter of Oddi.

The article discusses the current understanding of risk factors, mechanisms of development, diagnostic criteria, therapy for various types of functional disorders of the biliary tract. Paying special attention for the adaptation of diagnostic and treatment algorithms which were described in the Rome criteria, rev. IV, for ambulant practice to provide effective medical assistance to patients with the pathalogy. The authors proposed the scheme of treatment and prophylaxis of functional disorders for using in clinical practice.

The gallbladder is an organ that plays an important role in maintaining effective enterohepatic circulation (EHC) of bile and preserving the metabolic homeostasis of lipids and bile acids. Despite modern ideas about the role of the gallbladder in the human body, especially in subjects with metabolic syndrome and non-alcoholic fatty liver disease (NAFLD), cholecystectomy (CE) remains one of the most common surgeries, including in this patient category. The review examines the following in patients with NAFLD: the gallbladder role, the association between NAFLD and cholelithiasis (C), indications for CE, as well as the consequences of this intervention. The authors discuss the issues of patient management with NAFLD after CE. Patients with C and NAFLD who have undergone CE need a number of diagnostic measures aimed at identifying and timely correction of disorders, as well as complex treatment, which includes the risk factors elimination, strict adherence to diet, exercise regime, the use of drugs improving the EHC state, lipid and carbohydrate metabolism, the metabolic function of hepatocytes and inhibiting the liver fibrogenesis. KEYWORDS: cholecystectomy, non-alcoholic fatty liver disease, cholelithiasis, ursodeoxycholic acid, metabolic syndrome, insulin resistance. FOR CITATION: Mekhtiev S.N., Mekhtieva O.A., Ukhova M.V., Ibragimova Z.M. Modern view of the importance of cholecystectomy in the prognosis of a patient with non-alcoholic fatty liver disease: follow-up algorithm and therapeutic approaches. Russian Medical Inquiry. 2021;5(6):438–445 (in Russ.). DOI: 10.32364/2587-6821-2021-5-6-438-445.