Aspects of management of patients with cholelithiasis: clinical example

Abstract

Gallstone disease (GSD) is currently one of the most common diseases of the gastrointestinal tract, especially among people of working age, and has a clear tendency to increase and expand the age range towards rejuvenation. To date, the possible links in the pathogenesis of cholelithiasis have been well studied and described, risk factors and clinical manifestations have been studied and described, among which the asymptomatic course of cholelithiasis, which is often noted at the first latent stage of the disease, is important. It is at this stage that preventive conservative treatment allows most patients to avoid stone formation. However, after ascertaining biliary sludge, therapeutic correction is not carried out. Among the drugs used as oral litholytic therapy, ursodeoxycholic acid (UDCA) is used, which is effective for predominantly cholesterol (X-ray negative) calculi up to 15–18 mm in size or biliary sludge in the form of putty bile. It is known that UDCA changes the ratio of cholesterol/bile acids in bile, which contributes to the mobilization of cholesterol from gallstones and cause their partial or complete dissolution, and prevent the formation of new calculi. At the same time, the use of oral litholytic therapy is also possible at stage 2 of cholelithiasis with asymptomatic or rare attacks of biliary colic, the absence  of violations of the patency of the extrahepatic bile ducts, and also if        the patient does not agree to cholecystectomy in order to stabilize the process of stone formation. This article presents a review of the literature on the etiopathogenetic, clinical features of cholelithiasis, as well as the treatment of cholelithiasis, primarily with an emphasis on the prevention of this disease. An analysis of a clinical case is given with a discussion of rational pharmacocorrection in cholelithiasis.