Features of the course of gallstone disease in comorbid patients with non-alcoholic fatty liver disease

Abstract

Objective: to improve diagnostic and therapeutic tactics in patients with cholelithiasis in combination with NAFLD, taking into account the impact of comorbidity. Materials and methods: We examined 180 people who applied to the Lotos Medical Center in Chelyabinsk in the period 2018-2020 with cholelithiasis and NAFLD at the age of 19 to 65 years. The study included 128 women (72%) and 52 men (28%). The mean age of the participants was 51.3±9 years. The work took into account anamnestic (comorbid pathology) anthropometric data (height, body weight, body mass index, waist circumference). All patients underwent general clinical, biochemical blood tests, ultrasound of the abdominal cavity, MSCT of the abdominal cavity with an assessment of the density of liver tissue, bile and gallbladder stones. Results of the study: The study showed that among patients with cholelithiasis in combination with NAFLD, 56% had comorbidity. Gallstones of low density were found in 41.6%, high density in 58.4%. Comorbid pathology was represented by obesity, cardiovascular diseases, pathology of the endocrine system, diseases of the gastrointestinal tract and diseases of the kidneys and urinary system. In the group of patients with gallstones with a density of more than 75 Hounsfield units, comorbid pathology was more common, and the degree of liver steatosis and fibrosis was higher. During treatment with UDCA 15 mg/kg, positive dynamics was observed in patients with low-density stones: a decrease in stone density and size (effective litholysis), normalization of liver density, normalization of cytolysis, cholestasis, and carbohydrate metabolism. In patients with gallstones over 75 Hounsfield units, there was a decrease in bile density without effective litholysis, normalization of cytolysis stigmas, cholestasis, correction of lipid and carbohydrate metabolism. Conclusion: in patients with cholelithiasis in combination with NAFLD, comorbid pathology is more common, which negatively affects the effectiveness of litholysis and worsens the prognosis in these patients. Medical litholysis in these patients is possible only at the initial stage of the disease in the presence of stones of low density and size. UDCA therapy makes it possible to control the density of bile and the size of gallbladder stones, the activity of the inflammatory process in the liver, preventing the progression and complications of NAFLD and cholelithiasis in comorbid patients.