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1
Toouli, James. "Biliary tract motor dysfunction." Baillière's Clinical Gastroenterology 5, no. 2 (1991): 409–30. http://dx.doi.org/10.1016/0950-3528(91)90035-y.
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Shulpekova, Yu O., I. R. Popova, and V. M. Nechaev. "Functional Disorders of the Biliary Tract and Cholelithiasis: Analysis of a Possible Relationship." Russian Journal of Gastroenterology, Hepatology, Coloproctology 34, no. 4 (2024): 94–103. http://dx.doi.org/10.22416/1382-4376-2024-34-4-94-103.
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Aim: Diagnostic criteria for functional disorders of the biliary tract are presented in the materials of the Rome IV consensus, as well as expert councils of Russian and foreign specialists. Episodes of functional biliary pain are caused by a violation of bile outflow through the cystic duct and sphincter of Oddi. It has been suggested that there is a “biliary continuum” in which in some patients’ biliary dysfunction is transformed into cholelithiasis. Key points. Lithogenic bile is considered as the pathophysiological basis for the development of biliary dyskinesia and cholelithiasis. Lithogenic bile provokes inflammation of low grades in the mucous membrane of the biliary tract, decreased contractility of the gallbladder and impaired relaxation of the biliary sphincters, impaired physiological response to cholecystokinin. Changes in motility of the biliary tract may be associated with the influence of hydrophobic bile salts and impaired eicosanoid metabolism. Hyperplasia of the epithelium and muscle layer, hypersecretion of mucin and cholesterol precipitation further impair the outflow of bile. Experimental data and some clinical observations indicate the possibility of transformation of biliary dysfunction into cholelithiasis. Dysfunction of the sphincter of Oddi is one of the possible consequences of cholecystectomy and, in fact, acts as a variant of postcholecystectomy syndrome. The basis for the treatment of biliary dysfunctions are antispasmodics of different classes, which can be combined with ursodeoxycholic acid. The biliary tract-selective antispasmodic hymecromone has shown high effectiveness in relieving biliary pain, which also has a moderate choleretic effect and the ability to prevent the crystallization of cholesterol in bile and can be used both for functional diseases and for cholelithiasis. The domestic drug hymecromone “Odecromone” entered the pharmaceutical market. Conclusion. There is no doubt that the relevance of further study of the patterns of development of biliary dysfunctions and GI is obvious. The study of this problem will contribute to the development of effective preventive approaches, including in the field of nutraceuticals.
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Zakharova, I. N., I. V. Berezhnaya, and S. V. Shishkina. "Chronic constipation combined with biliary tract dysfunction in children: comorbidity or clinical regularity?" Medical Council, no. 17 (November 24, 2019): 130–36. http://dx.doi.org/10.21518/2079-701x-2019-17-130-136.
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Functional disorders of the gastrointestinal tract (GIT) are a common problem in children. The Roman IV criteria adopted in 2016, devoted to the problem of constipation and biliary tract dysfunction in children are developed in accordance with age and are idendoitified by the letter code. This article presents data on the correspondence of the Roman IV criteria and ICD-10 in the combined problem of constipation and biliary tract dysfunction in children. The development of upper gastrointestinal tract pathology caused by increased intracavitary pressure associated with impaired colon motility (chronic constipation) is natural during a prolonged course of chronic constipation. The study based on a specially designed questionnaire in Russia showed that an average of 54% of children in different age groups suffer from chronic constipation, that is, almost every second child. Studies showed that the frequency of biliary tract dysfunction in children with chronic constipation accounts for 42.3 to 100% cases. The survey that we conducted among pediatricians showed that a quarter of doctors found it difficult to establish diagnosis, and 41% of pediatricians struggled with prescribing therapy for persistent constipation in children, especially constipation combined with motor-tonic dysfunction of the colon in children with biliary tract dysfunction. A total of 201 children aged 6 to 15 years (96 boys and 114 girls) were enrolled in the study. In addition to pain syndrome, cellular energy exchange disorder in the form of decreased level of intracellular antioxidant catalase enzyme and plasma antioxidant activity (PAO) was identified against the background of chronic constipation and biliary tract dysfunction in this group of children, which is evidence of decompensation of antioxidant protection in the acute stage of biliary tract dysfunctional disorders in children. The identified changes make a strong case for prescribing a drug with hepatoprotective, choleretic and antioxidant effects. The use of herbal extract of fresh artichoke leaves (Chophytol®, Mayoly Spindle, France) showed the relief of pain syndrome by Day 14 of treatment in 92% of patients (75% in the comparison group), nausea in 74% of children, constipation in 88% (50% of patients in the comparison group). It is important to detect an elevated α-tocopherol level and significantly reduced catalase level, which indicates the need to choose a drug with selective antioxidant activity, which does not change the α-tocopherol level. The introduction of the herbal extract of fresh artichoke leaves (Chophytol®) in the complex therapy of the studied patients accelerated the relief of the clinical symptoms of functional biliary tract disorders and reduced the frequency of constipation in children by 4 times as compared with the control group without significant effect on the α-tocopherol level.
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Zakharova, I. N., M. I. Pykov, I. V. Berezhnaya, et al. "Functional disorders of the biliary tract. What a pediatrician needs to know." Medical Council, no. 11 (July 16, 2018): 91–102. http://dx.doi.org/10.21518/2079-701x-2018-11-91-102.
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According to the frequency of contact with a doctor, abdominal pain in children is second only to respiratory diseases. Since the pain syndrome is a nonspecific manifestation of various pathologies, the doctor faces a serious diagnostic task, which is especially difficult in pediatric practice. One of the frequent causes of abdominal pain in children is a disruption of the function of the digestive tract, in particular, the dysfunction of the billiard tract. The article considers etiopathogenetic mechanisms of development of functional disorders of the biliary tract in children, classification in the light of the Rome IV consensus, modern low-invasive methods for diagnosing dysfunctions of the biliary tract. The ultrasound of the hepatobiliary zone was assessed. Questions are given for self-control.
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Minushkin, O. N., L. V. Maslovsky, N. V. Lvova, et al. "Biliary dysfunction (according to recommendations of Rome IV): diagnosis, treatment." Medical alphabet, no. 10 (June 17, 2020): 5–10. http://dx.doi.org/10.33667/2078-5631-2020-10-5-10.
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The paper presents information on modern functional disorders of the gastrointestinal tract and biliary system, based on the recommendations of the Rome IV. Own studies on the effectiveness of treatment of biliary functional disorders with Niaspam (mebeverine hydrochloride) are presented. We studied 30 patients with biliary pain and functional disorders of the gallbladder. As a result of studies, it was found that the symptoms of biliary dysfunction stop in 83.3 % of patients, the contractility of the gallbladder is restored in 86.7 %. No side effects have been reported.
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Kucheryavyy, Yu A., and M. F. Osipenko. "Chronic acalculous cholecystitis and biliary dysfunction: how does clinical diagnosis affect management?" Meditsinskiy sovet = Medical Council, no. 5 (May 13, 2021): 54–61. http://dx.doi.org/10.21518/2079-701x2021-5-54-61.
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Similar abdominal pain of biliary type in functional disorders of biliary tract and chronic acalculous cholecystitis causes objective difficulties to differentiate not only between each other, but also with other diseases of gastrointestinal tract. The clinical picture is so homogeneous and difficult to distinguish from cholelithiasis that some patients undergo unreasonable surgical interventions for CAC and FDBT. Individual publications pushing for such an aggressive strategy are sporadic and need to be clarified in larger studies. The first choice drugs for treatment of FDBT are spasmolytics; ursodeoxycholic acid drugs are used as adjuvant agents. In CAC, the initial therapy will be similar, but the treatment regimen can be expanded with targeted etiotropic (if the cause of cholecystitis is identified – giardiasis, opisthorchiasis, etc.) or empirical antimicrobial/antiparasitic therapy. The greatest interest today is caused by hymecromone – a drug with proven by both experimental and controlled studies combined choleretic, selective spasmolytic action, mediated effect of reducing bile lithogenicity and possible anti-inflammatory action. Hymecromone effectively relieves biliary pain without causing gallbladder contractions, which determines the possibility of its wide application both in CAC and FDBT, both in monotherapy and in combination with other agents, primarily with UDCA. In this article the issues of optimization of diagnostic and therapeutic strategy of management of patients with biliary pain to avoid unreasonable cholecystectomies in acalculous diseases of the biliary tract are considered.
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Shelukhina, S. V., A. S. Vasilevskaya, E. V. Markova, M. A. Butov, O. A. Maslova, and I. A. Zagravskaya. "Features of the management of patients with biliary dysfunctions with spasm of the sphincter of Oddi." Medical alphabet, no. 5 (May 7, 2024): 18–22. http://dx.doi.org/10.33667/2078-5631-2024-5-18-22.
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The aim. Assessment of clinical manifestations of biliary dysfunction, duodenal hypertension. The analysis of data on the effect of drugs of various pharmacological groups on the motor function of the gallbladder is carried out.Materials and methods. We were examined 60 patients (18–50 years old, mean age 41±4.6 years), mostly women (44). All patients underwent a general clinical examination, including blood and urine tests, biochemical blood parameters, ultrasound examination of the abdominal organs and monitoring of gallbladder contractility, esophagogastroduodenoscopy. The examined patients were divided into 2 groups of 30 patients.Results and conclusion. The use of choleretics for spasm of the sphincter of Oddi and symptoms of duodenal hypertension is not always justified. The leading link in the treatment of this type of biliary dysfunction are antispasmodics, which eliminate spasm of the sphincter zones, which restores the passage of bile through the biliary tract and reduces the phenomena of biliary insufficiency. Mebeverine hydrochloride also eliminates the phenomena of duodenal hypertension, which facilitates the removal of bile from the biliary tract. When choleretics are prescribed for the treatment of patients with biliary dysfunction with spasm of the sphincter of Oddi, it is quite possible that the course of this pathology will worsen.
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Sorokman, T. V., L. Yu Khlunovska, and I. Ya Lozyuk. "Frequency of involvement different parts of the gastrointestinal tract in the pathological process in children with biliary dysfunction." Modern pediatrics. Ukraine, no. 4(116) (May 26, 2021): 24–28. http://dx.doi.org/10.15574/sp.2021.116.24.
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The close anatomical and physiological connection of the digestive organs leads to a significant spread of functional disorders in various diseases. Purpose — to investigate the frequency and features of the clinical course of biliary dysfunction (BD) in children. Materials and methods. 66 children aged 10–18 years with BD were examined. The study included a complete clinical examination of children, laboratory and instrumental methods. To assess the severity of clinical symptoms in the examined patients was used traditional score scale of symptoms (0–3 points) and the frequency index (FI). Results. In most children, the database was combined with other functional and organic lesions of the digestive tract (n=56, 84.8%). The database was most often combined with chronic gastritis and duodenitis, as well as with functional motor disorders. FI in children with BD involved in the pathological process of the stomach and duodenum was the highest (0.59), and IR in children with BD and intestinal involvement was the lowest (0.23). The relationship between the frequency of combined pathology and the frequency of cases of increase in the size of the gallbladder (χ2=22.87 at a critical value of χ2=9.33 for the significance level p<0.01). Hyper- or hypofunctions of the biliary tract occurred with the same frequency. Conclusions. Biliary dysfunction in children is significantly more often combined with chronic gastritis and duodenitis, as well as with other functional disorders of the gastrointestinal tract (duodenogastric reflux). In children with biliary dysfunction and involvement in the pathological process of other parts of the gastrointestinal tract there is an increase in the frequency of exacerbations, more pronounced signs of dyspeptic syndrome on the background of pain with the same intensity and more often ultrasound reveals signs of gallbladder dysformation. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local Ethics Committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: children, biliary dysfunction.
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Glick, Michael E., John C. Hoefs, and Hooshang Meshkinpour. "Glucose Intolerance and Hepatic, Biliary Tract and Pancreatic Dysfunction." Digestive Diseases 5, no. 2 (1987): 78–96. http://dx.doi.org/10.1159/000171165.
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Шестопалова, Є. С., С. А. Калмиков, and Ю. С. Калмикова. "Current issues of physical therapy in biliary tract dysfunction." Physical rehabilitation and recreational health technologies 5, no. 1 (2020): 52–57. http://dx.doi.org/10.15391/prrht.2020-5(1).07.
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Мета: розглянути особливості застосування фізичної терапії при дисфункції біліарного тракту. Матеріал і методи: теоретичний аналіз і узагальнення сучасних наукових даних щодо особливостей застосування реабілітаційних засобів при дисфункціональних розладах біліарного тракту. Результати: розглянуто механізм лікувальної дії фізичних вправ при дисфункції біліарного тракту; визначено особливості застосування фізичної терапії у період ремісії. Висновки: фізична терапія є невід´ємною частиною медичної реабілітації при дисфункціональних розладах біліарного тракту і залежить від форми дискінезії (гіпертонічно-гіперкінетична або гіпотонічно-гіпокінетична форма) та наявності органічної патології печінки, системи жовчовиділення, дванадцятипалої кишки, шлунку, товстого кишечника та інших органів.
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Alymbaev, E., V. Malevannaya, and G. Kozhonazarova. "Clinical characteristic of biliary tract dysfunction in children in the Kyrgyz Republic." Bulletin of Science and Practice 5, no. 2 (2019): 59–66. http://dx.doi.org/10.33619/2414-2948/39/07.
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The article presents clinical, laboratory, instrumental data in children with functional biliary dyskinesias. Studies were conducted for the period 2014–2018. on the clinical base of the National Center for Maternal and Child Welfare. The object of the study were 120 children from 7 to 14 years. It has been established that the formation of a symptom complex in most cases is ambiguous and develops against the background of various diseases that were previously experienced. The presence of a large variation in the duration of the disease indicates a delayed diagnosis of pathology. Determining the type of biliary dyskinesia allows you to choose the most effective treatment regimen.
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Alymbaev, E., V. Malevannaya, and G. Kozhonazarova. "Clinical characteristic of biliary tract dysfunction in children in the Kyrgyz Republic." Bulletin of Science and Practice 5, no. 2 (2019): 59–66. https://doi.org/10.33619/2414-2948/39/07.
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The article presents clinical, laboratory, instrumental data in children with functional biliary dyskinesias. Studies were conducted for the period 2014–2018. on the clinical base of the National Center for Maternal and Child Welfare. The object of the study were 120 children from 7 to 14 years. It has been established that the formation of a symptom complex in most cases is ambiguous and develops against the background of various diseases that were previously experienced. The presence of a large variation in the duration of the disease indicates a delayed diagnosis of pathology. Determining the type of biliary dyskinesia allows you to choose the most effective treatment regimen.
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Malevannaya, V. "Combined therapy in children with functional disorders of the biliary tract." Bulletin of Science and Practice 5, no. 2 (2019): 73–78. https://doi.org/10.33619/2414-2948/39/09.
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The paper presents data on the evaluation of complex treatment of children with biliary dysfunction according to the results of a clinical ultrasound study with the determination of the motor function index of the gall bladder.
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Malevannaya, V. "Combined therapy in children with functional disorders of the biliary tract." Bulletin of Science and Practice 5, no. 2 (2019): 73–78. http://dx.doi.org/10.33619/2414-2948/39/09.
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The paper presents data on the evaluation of complex treatment of children with biliary dysfunction according to the results of a clinical ultrasound study with the determination of the motor function index of the gall bladder.
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Okhlobystin, A. V., and A. K. Ufimtseva. "Hymecromone in the treatment of biliary diseases: options and prospects." Voprosy detskoj dietologii 18, no. 5 (2020): 66–74. http://dx.doi.org/10.20953/1727-5784-2020-5-66-74.
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Pharmacological treatment of biliary dyskinesia is to a great extend aimed at reducing smooth muscle spasms and recovering gallbladder motility. Prolonged courses of myotropic antispasmodics are used as the basic therapy. Hymecromone is notable to its predominantly spasmolytic action on the bile ducts and the sphincter of Oddi without any significant effect on the gallbladder contractility, and therefore it is safe in patients with cholecystolythiasis. Hymecromone decreases the severity of cholestasis, prevents the formation of cholesterol crystals and therefore, the development of cholelithiasis. It is effective both as a monotherapy and in combination with ursodeoxycholic acid for treatment of biliary sludge and prevention of the progression of gallstone disease. Its local action on the biliary tract and low systemic bioavailability after oral intake increases the treatment safety. Experimental studies demonstrated the antifibrotic and antihyperglycaemic effect of the drug. Key words: biliary dysfunction, cholelithiasis, sphincter of Oddi dysfunction, biliary sludge, hymecromone, ursodeoxycholic acid
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Bueverov, A. О. "Sphincter of Oddi dysfunction in the post-cholecystectomy period." Meditsinskiy sovet = Medical Council, no. 15 (October 22, 2020): 90–95. http://dx.doi.org/10.21518/2079-701x-2020-15-90-95.
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The persistent post-cholecystectomy (CE) symptoms can be divided into four groups: 1) surgical errors; 2) recurrence of cholelithiasis; 3) functional disorders due to removal of the gallbladder (transient or persistent); 4) pathology not associated with CE. Biliary pain persists in 20–40% of patients after CE, in most cases caused by sphincter of Oddi dysfunction (SOD). SOD is subdivided into biliary, pancreatic, two-duct types, as well as pancreatobiliary reflux. The SOD is rooted in the increased pressure in the sphincter, which leads to the increased intraductal pressure and, as a result, to the occurrence of biliary or pancreatic pain. In addition, the direct contractile effects of cholecystokinin on smooth muscles of the biliary tract change due to mechanical disturbance of innervation. Hypertension of the pancreatic part of the sphincter of Oddi can cause not only the occurrence of functional pain of the pancreatic type, but also the development of recurrent pancreatitis. SOD is characterized by typical anamnestic data that are common to the functional pathology of the digestive system, such as duration of symptoms, absence of organic pathology, multiple complaints, a non-progressive course, the provoking role of psychoemotional factors. From a practical standpoint, the clinical criteria for SOD can be: 1) an attack of biliary or pancreatic pain; 2) a transient increase in the activity of hepatic or pancreatic enzymes; 3) transient expansion of the common bile or major pancreatic duct. If it is difficult to differentiate diagnosis, endoscopic ultrasonography is advisable. Antispasmodics and ursodeoxycholic acid form the basis of the treatment, especially when biliary sludge and microlithiasis are detected. There must be strong arguments for the surgical treatment.
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Dicheva, D. T., A. Yu Goncharenko, A. V. Zaborovsky, D. V. Privezentsev, and D. N. Andreev. "Functional disorders of the biliary tract: modern diagnostic criteria and principles of pharmacotherapy." Meditsinskiy sovet = Medical Council, no. 11 (August 8, 2020): 116–23. http://dx.doi.org/10.21518/2079-701x-2020-11-116-123.
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The review article presents current data on functional disorders of the biliary system, taking into account the latest recommendations of experts of the Rome Foundation (Rome Criteria IV, 2016) and the Russian Gastroenterological Association (specialized clinical recommendations, 2018). According to modern concepts, biliary dysfunction is a group of functional disorders of the biliary system caused by motor disorders and increased visceral sensitivity. According to the literature data, the prevalence of functional disorders of GB and OS is 10-15%, and violation of OS function is revealed in 30-40% of patients who underwent cholecystectomy (CE). The presence of biliary pain is an obligatory condition in the diagnosis of functional disorders of GB and OS. Bilirubin and serum transaminases (AST, ALT) levels may increase in biochemical blood analysis in patients with functional OS disorder of biliary type, and pancreatic amylase and lipase in case of functional OS disorder of pancreatic type. Ultrasound examination of abdominal organs is considered to be the priority among instrumental methods. This technique allows to exclude organic lesions of both the GB and visualized ducts, and adjacent organs (GSD, biliary tract, liver and pancreas neoplasms). Magnetic resonance cholangiopancreatography (MRCP) is used as a clarifying method, which allows to visualize the state of biliary ducts throughout. Ultrasonic cholecystography is used to assess the contractile activity of the GB. When duct dilation is detected and/or when liver/pancreatic enzyme levels are elevated in the absence of changes according to MRCP data, it is reasonable to perform an endoscopic ultrasound examination. According to the latest recommendations of the Russian Gastroenterological Association (2018), the foundation of pharmacotherapy for this group of diseases are antispasmodics and ursodeoxycholic acid (UDCA).
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Lukianenko, O. Yu, and T. I. Panteleeva. "Dysfunction of the biliary tract in children: traditional approaches and new postulates." GASTROENTEROLOGY 51, no. 3 (2017): 213–21. http://dx.doi.org/10.22141/2308-2097.51.3.2017.112640.
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Birg, N. A. "About dysfunction of the pancreas in diseases of the liver and biliary tract." Kazan medical journal 43, no. 3 (2021): 19–21. http://dx.doi.org/10.17816/kazmj83555.
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The possibility of secondary lesions of the pancreas in inflammation of the biliary tract was pointed out by Kleps (1872). The most complete description of morphological changes in the pancreas in liver diseases was given by G.K. Rodionov (1883). A number of contemporary authors have also devoted their works to this issue: I. G. Rufanov, M. M. Gubergrits, N. I. Leporsky, I. T. Kurtsin, M. S. Rozhkova, Volgemut, Schmidt, Wiesend, A. F. Kiseleva and others.
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Seliverstov, P., V. Kutsenko, E. Ivanyuk, and Yu Kravchuk. "Possibilities of diagnosis, treatment and prevention of functional diseases of the gallbladder and sphincter of Oddi." Vrach 34, no. 9 (2023): 65–71. http://dx.doi.org/10.29296/25877305-2023-09-13.
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The detection of functional disorders of the gastrointestinal tract is statistically reliable in almost 50% of patients, of which about 15% are biliary disorders of the adult population. The gallbladder accounts for more than 12.5% of all biliary disorders, which proves the significant contribution of this pathology to the overall statistics of gastrointestinal morbidity. Currently, the treatment, differential diagnosis of this pathology is associated with a number of difficulties, and first of all this is due to various anatomical features of the gallbladder and excretory ducts. The diagnosis of this pathology, especially the motility of the gallbladder, requires the use of modern medications, such as Hofitol, which provides a pronounced hepatoprotective effect in the form of normalization of enzyme activity, bilirubin levels, lipid composition, effectively eliminates the main clinical manifestations of bile sludge, dysfunction of the gastrointestinal tract, restores its motor evacuation function and is well tolerated by patients.
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Tolmacheva, Olga G., Olga Yu Ustinova, Olga A. Maklakova, Yulia A. Ivashova, and Alexsandra Yu Vandisheva. "Features of formation of biliary dysfunctions in children consuming drinking water with high nitrate content." Perm Medical Journal 36, no. 5 (2019): 65–70. http://dx.doi.org/10.17816/pmj36565-70.
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Introduction. In recent years, there is more and more information about the global distribution of nitrates in soil, water, food.
 Purpose. To study the features of the formation of biliary dysfunction in children with drinking water with high nitrate content.
 Materials. 124 school-age children consuming drinking water with high nitrate content (1.3 MPC) were examined. The comparison group included 52 children living in areas where the nitrate level in drinking water was 4.7 times lower. Results. In children of the observation group, the concentration of N-nitrosodimethylamine in the blood was 3.3 times higher than in the comparison group, and the concentration of nitrates in urine was 1.8 times higher. Every second child with a pathology of the gastrointestinal tract consuming drinking water with a high content of nitrates was diagnosed with biliary dysfunction manifested by hepatocellular dysfunction (increased activity of AST) and a violation of motor-tonic function of the gallbladder by hyperkinetic type against the background of hemolysis of erythrocytes (increased total bilirubin) with a stable level of hemoglobin.
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Ivashkin, V. T., Ch S. Pavlov, I. R. Popova, and Yu O. Shulpekova. "Trimebutine maleate in the treatment of functional biliary disorders: TRIBUNE study results." Medical Council, no. 21 (January 20, 2019): 117–25. http://dx.doi.org/10.21518/2079-701x-2018-21-117-125.
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Introduction. The term «functional disorders of the biliary tract and bile ducts» defines the conditions, which produce typical patterns of biliary pains in the absence of obvious signs of organic lesions of the gallbladder and bile ducts. The materials of the Rome IV consensus present the diagnostic criteria of their main types – functional disorders of the gall bladder and sphincter of Oddi. Vasilenko Clinic of Internal Diseases Propedeutics, Gastroenterology and Hepatology of the University Clinical Hospital No. 2 of Sechenov University carried out a noninterventional observational program to study the experience in using Trimedat® (trimebutine maleate) in the routine outpatient and inpatient practice in the treatment of patients with functional diseases of the biliary tract. Information partners of the program are the Russian Gastroenterological Association (RGA) and the Russian Society for the Study of the Liver (RSSL).Materials and methods. The program included patients of both sexes aged 18 to 65 years with ICD-10 diagnoses «spasm of the sphincter of Oddi» (K 83.4), «postcholecystectomy syndrome» (K 91.5), «other specified diseases of the gallbladder» (K 82.8) , «other specified diseases of the bile ducts» (K 83.8), «disorders of gallbladder and biliary tract in diseases classified elsewhere» (K 87.0), if the clinical picture was consistent with functional biliary disorders according to the Rome IV criteria and in cases when the doctor decided to prescribe Trimedat® therapy. Patients were observed for 28 ± 1 days. The dynamics of biliary pain and discomfort, as well as other symptoms (in particular, nausea, flatulence) were evaluated on the background of the therapy, using the Gastrointestinal Symptom Score Scale, in which the severity of each symptom is estimated by 7 grades (Alekseev N.Yu., 2006) with adding a section to evaluate the biliary disorders. In the presence of criteria for functional disorders of the gallbladder, an ultrasound control of the fraction of its discharge was carried out before and after the therapy.Results. 100 patients (33 (33%) men and 67 (67%) women, the average age 42.2 ± 13.2 years (18–65 years)) were enrolled in the program. In accordance with the Rome IV Consensus, the majority of patients (83 (83%)) had the functional disorders of GB; in 16 (16%) patients with the removed GB, the picture corresponded to the functional disorder of SO, one patient with kept GB was diagnosed with SO dysfunction. The treatment with Trimedate® at a standard dosage resulted in a decrease in the proportion of pain in the epigastric region (in the Scale section evaluating the biliary tract symptoms), the degree of nausea and bloating. Differences between the visits were estimated by the Friedman’s test, p <0.001. In addition, other sections of the scale also showed a decrease in indicators in scores. 79 patients underwent repeated ultrasound cholecystography at the end of treatment. It showed an increase in the fraction of GB emptying.Conclusions. The use of Trimedate® in patients with functional disorders of the gall bladder and sphincter of Oddi resulted in the reduction of the severity of the main symptoms - the severity of biliary pain, nausea, bloating. The patients with GB dysfunction showed an increase in the fraction of GB emptying.
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Rees, James, Jemma Mytton, Felicity Evison, Kamarjit Singh Mangat, Prashant Patel, and Nigel Trudgill. "The outcomes of biliary drainage by percutaneous transhepatic cholangiography for the palliation of malignant biliary obstruction in England between 2001 and 2014: a retrospective cohort study." BMJ Open 10, no. 1 (2020): e033576. http://dx.doi.org/10.1136/bmjopen-2019-033576.
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IntroductionRelieving obstructive jaundice in inoperable pancreato-biliary cancers improves quality of life and permits chemotherapy. Percutaneous transhepatic cholangiography with drainage and/or stenting relieves jaundice but can be associated with significant morbidity and mortality. Percutaneous transhepatic biliary drainage (PTBD) in malignant biliary obstruction was therefore examined in a national cohort to establish risk factors for poor outcomes.MethodsRetrospective study of adult patients undergoing PTBD for palliation of pancreato-biliary cancer in England between 2001 and 2014 identified from Hospital Episode Statistics. Multivariate logistic regression analysis was used to examine associations with mortality and the need for a repeat PTBD within 2 months.Results16 822 patients analysed (median age 72 (range 19–104) years, 50.3% men). 58% pancreatic and 30% biliary tract cancer. In-hospital and 30-day mortality were 15.3% (95% CI 14.7% to 15.9%) and 23.1% (22.4%–23.8%), respectively. 20.2% suffered a coded complication within 3 months. Factors associated with 30-day mortality: age (≥81 years OR 2.68 (95% CI 2.37 to 3.03), p<0.001), increasing comorbidity (Charlson score 20+, 3.10 (2.64–3.65), p<0.001), pre-existing renal dysfunction (2.37 (2.12–2.65), p<0.001) and non-pancreatic cancer (unspecified biliary tract 1.28 (1.08–1.52), p=0.004). Women had lower mortality (0.91 (0.84–0.98), p=0.011), as did patients undergoing PTBD in a ‘higher volume’ provider (84–180 PTBDs per year 0.68 (0.58–0.79), p<0.001).ConclusionsIn patients undergoing PTBD for the palliation of malignant biliary obstruction, 30-day mortality was high at 23.1%. Mortality was higher in older patients, men, those with increasing comorbidity, a cancer site other than pancreas and at ‘lower-volume’ PTBD providers.
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Suda, Kosuke, Masayuki Ohtsuka, Satoshi Ambiru, et al. "Risk factors of liver dysfunction after extended hepatic resection in biliary tract malignancies." American Journal of Surgery 197, no. 6 (2009): 752–58. http://dx.doi.org/10.1016/j.amjsurg.2008.05.007.
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Kolesnik, K., Natal'ya Kaladze, and S. Severinova. "CLINICAL ASSESSMENT OF THE MAINTENANCE THERAPY EFFICACY IN THE ORTHODONTIC TREATMENT OF ADOLESCENTS WITH CHRONIC DISEASES OF THE UPPER PART GASTROINTESTINAL TRACT." Tavricheskiy Mediko-Biologicheskiy Vestnik 23, no. 3 (2022): 39–44. http://dx.doi.org/10.29039/2070-8092-2020-23-3-39-44.
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The aim of the work is to provide a clinical assessment of the efficacy of therapy for accompanying orthodontic treatment of adolescents with chronic diseases of the upper part gastrointestinal tract. Material and methods. There were 109 adolescents at the age of 12–15 years with dental anomalies and gastroduodenal pathology (chronic gastritis, chronic gastroduodenitis, biliary dysfunction) were taken for orthodontic treatment. The state of oral hygiene, periodontal tissues and hard tooth tissues in the dynamics of orthodontic treatment was evaluated. We used the Silness-Loe and Stallard hygiene indexes, periodontal indexes – PMA, stomatorrhagia, Schiller-Pisarev, dental calculus, and calculated the reduction of caries.
 Results. Phased application of accompanying therapy (a calcium preparation with vitamin D3 and trace elements (Calcemin), magnesium (Magne B6), an immunostimulating drug of bacterial origin (Imudon) for the orthodontic treatment of adolescents with chronic pathology of the digestive tract shows an anti-inflammatory and caries static effect.
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Ferfetska, K. V., D. O. Hontsaryuk, L. O. Pits, and V. A. Pits. "Biliary pancreatitis: modern approaches to treatment (literature review)." Herald of Pancreatic Club 62, no. 1 (2024): 15–22. https://doi.org/10.33149/vkp.2024.01.02.
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The purpose of the literature review was to examine the modern approach to treating biliary pancreatitis, which is characterized by a combination of exocrine pancreatic insufficiency and chronic biliary insufficiency and impairs the digestive process. The primary cause of biliary pancreatitis is bilioduodenal hypertension, which results in the reflux of bile into the pancreatic duct and the activation of pancreatic enzymes in the pancreatic ductal system. The causes of biliary hypertension may be functional or organic. Functional biliary disorders refer to a cluster of clinical symptoms caused by motor-tonic dysfunction of the gallbladder and/or biliary tract sphincter apparatus. Organic causes of biliary hypertension are mostly represented by biliary sludge, choledocholithiasis, stenotic papillitis, strictures and cysts of the distal common bile duct, compression of the common bile duct by a tumor, enlarged head of the pancreas, adhesions, enlarged lymph nodes or paraphageal diverticulum (especially with diverticulitis), failure of the major duodenal papilla due to papillosphincterotomy, arterio-mesenteric obstruction, lymphadenitis in the area of the Treitz ligament, afferent loop syndrome after gastrectomy, helminthic infestation, autoimmune or primary sclerosing cholangitis, tumors of the bile ducts or major duodenal papilla. Special emphasis is placed on the characteristics of drug therapy, the pharmacotherapeutic mechanisms of action of various antispasmodics and choleretic agents, and the effects of ursodeoxycholic acid on the mechanisms of the development of biliary disorders associated with chronic pancreatitis.
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Kirkegård, Jakob, Dora Körmendiné Farkas, Jens Otto Lunde Jørgensen, and Deirdre P. Cronin-Fenton. "Hyperthyroidism or hypothyroidism and gastrointestinal cancer risk: a Danish nationwide cohort study." Endocrine Connections 7, no. 11 (2018): 1129–35. http://dx.doi.org/10.1530/ec-18-0258.
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Objective The association between thyroid dysfunction and gastrointestinal cancer is unclear. Design We conducted a nationwide population-based cohort study to examine this potential association. Methods We used Danish medical registries to assemble a nationwide population-based cohort of patients diagnosed with hyperthyroid or hypothyroid disease from 1978 to 2013. We computed standardized incidence ratios (SIRs) with corresponding 95% CIs as measures of the relative risk of each cancer, comparing patients with thyroid dysfunction with that expected in the general population. Results We included 163,972 patients, of which 92,783 had hyperthyroidism and 71,189 had hypothyroidism. In general, we found an increased risk of all gastrointestinal cancers within the first year after thyroid disease diagnosis. After more than 5 years of follow-up, patients with hyperthyroidism had a slightly increased risk of pancreatic and gallbladder and biliary tract cancer. Patients with hypothyroidism had a slightly increased risk of stomach, anal, liver, gallbladder and biliary tract, and pancreatic cancer after more than 5 years of follow-up, but the observed numbers of cancers were in general similar to the expected. Conclusions The increased risks of all gastrointestinal cancers in the first year following hyper- or hypothyroidism diagnosis are likely due to detection bias. After more than 5 years of follow-up, there does not seem to be a consistent causal association between thyroid disease and gastrointestinal cancer.
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Sorokman, T. V., and V. G. Ostapchuk. "THE LEVEL OF ZINC IN BLOOD PLASMA AND THE COURSE OF GALLSTONE DISEASE IN CHILDREN." Bukovinian Medical Herald 27, no. 1 (105) (2023): 61–66. http://dx.doi.org/10.24061/2413-0737.27.1.105.2023.11.
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Determining the zinc level in children's blood plasma is an urgent problem, given its possible participation in the formation of cholelithiasis.Aim. To investigate the level of zinc in the blood plasma and the clinical course of gallstone disease (GSD) in children.Methods. 69 children aged 10-17 years and 25 children without biliary tract pathology were selected by the method of simple randomization. Verification of the diagnosis was carried out by applying dynamic ultrasound examination and X-ray examination of the organs of the abdominal cavity. Quantitative determination of zinc in blood plasma was carried out using mass spectrometry.Results. Dysfunction of the biliary tract according to the hyperkinetic type occurred in 55.1±7.1% of children and according to the hypokinetic type in 44.9±3.9%. The asymptomatic variant of housing and communal services was observed in 23.9%, painful - in 54.3% of patients, paroxysmal - in 21.7% of patients. The plasma concentration of zinc in children with gastrointestinal diseases was 1.87 times lower than in children of the comparison group and 1.37 times lower than in children with hyperkinetic gallbladder dysfunction, while there was a probable difference between these indicators in children with housing and communal services and in children with the hypotonic type of gallbladder dysfunction (p<0.05).Conclusions. 1. The leading syndromes of gallstone disease in children were pain and dyspepsia. 2. Gallstone disease in children occurs against the background of gallbladder dysfunction with a predominance of the painful course, the formation of solitary bilirubin-derived concretions and minor changes in biochemical blood analysis. 3. The concentration of zinc in the blood plasma of children with gallstone disease is probably lower than in children of the comparison group and does not depend on age and gender.
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Ryckman, Frederick C., Frederick J. Suchy, Israel Penn, J. Wesley Alexander, Timothy J. Schroeder, and William F. Balistreri. "Complications associated with the treatment of rejection in pediatric liver transplant patients." Clinical Transplantation 2, no. 4 (1988): 169–76. http://dx.doi.org/10.1111/j.1399-0012.1988.tb00499.x.
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The management of complications following hepatic transplantation in children requires a directed approach to their early recognition and diagnosis in order to avoid misinterpretation of clinical and biochemical abnormalities and inappropriate modifications in the immunosuppressive regimen. Abnormal screening laboratory tests serve to signal the presence of allograft dysfunction, but do not allow specific definition of recurrent or persistent rejection, infection, biliary duct complications, or drug hepatotoxicity in patients undergoing primary therapy for allograft rejection. Use of a consistent radiographic screening protocol employing computed tomography of the abdomen, real‐time and doppler ultrasound, and biliary imaging allows the early recognition of technical abnormalities within the allograft. Percutaneous hepatic biopsy is essential to define complications of recurrent or persistent rejection vs infection and drug‐related hepatotoxicity. Utilizing this directed diagnostic protocol, 15 pediatric hepatic transplant patients have been successfully managed with only one retransplantation required for graft lost due to irreversible rejection, and no mortality from infection‐related or biliary tract complications.
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Malevannaya, V., E. Alymbaev, and O. Atykanov. "Evaluation of Treatment of Biliary Tract Dysfunction in Children by the Activity of the Cytokine System." Bulletin of Science and Practice 6, no. 7 (2020): 133–38. https://doi.org/10.33619/2414-2948/56/15.
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The study presents data on the examination of 100 children aged 7 to 14 years with a disturbance of the motor-evacuation function of the bile excreting system in the hypomotor type (57 children — I clinical group) and hypermotor type (43 children — II clinical group). As a control group, 20 somatically healthy children were examined. It was shown that with hypomotor dyskinesia of the gallbladder, the activity of the cytokine (interleukin) system in the blood plasma was significantly superior to activity in hypermotor dyskinesia. Combined therapy in children’s second clinical group leads to normalization of blood levels of interleukins, whereas the children of the first clinical group stored in elevated blood concentrations of interleukin closure during treatment.
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Yuksel, Melih, Murat Yildar, and Erdogan Bulbul. "The Role of MRCP on Management of the Acute Biliary Pancreatitis." Medical Science and Discovery 2, no. 6 (2019): 319–22. https://doi.org/10.36472/msd.v2i6.75.
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Acute pancreatitis (AP) an acute inflammation of the pancreas, is the most common cause of admission to hospital because of acute gastro-intestinal tract in the USA. In etiology, factors such as cholelithiasis, alcohol, drugs, hypertriglyceridemia, and sphincter of oddi dysfunction play a role. Acute biliary pancreatitis (ABP) constitutes %40 of all pancreatitis cases. The management of patients with ABP are vital for the cases in which choledocholithiazis exists. This review focuses on the management of such patients. The timing of ERCP and the use of MRCP was investigated in this review. For this review, various studies and reviews were critically evaluated.
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Belash, V. O., E. Yu Zavadsky, and A. I. Zueva. "Evaluation of the clinical effectiveness of osteopathic gallbladder drainage techniques." Russian Osteopathic Journal, no. 3 (September 14, 2024): 47–57. http://dx.doi.org/10.32885/2220-0975-2024-3-47-57.
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Introduction. In recent decades, a lot of new materials about etiology and pathogenesis of biliary system diseases have been obtained and new effective drugs have been introduced. But, despite this, there remains much unrecognized and controversial in etiopathogenesis and principles of treatment of the disease. Moreover, the frequency of complicated forms of the disease and the overall incidence of biliary pathology continues to grow, which clearly shows the need to search for new approaches to diagnosis and treatment of these conditions. The leading causes of biliary tract pathology formation, actual problems of pharmacotherapy (allergic reactions, side effects, polypragmasy), certain aspects of comorbid pathology make clinicians pay closer attention to non-medicament treatment methods, including osteopathic correction. Previous studies have already demonstrated a good clinical effect of osteopathic correction in the treatment of patients with biliary disorders. At the same time, most studies in osteopathy present an assessment of the possibility of using osteopathic correction in the treatment of certain nosological forms. But no less important, in our opinion, is to conduct studies aimed at evaluating the clinical effectiveness (efficiency) of individual osteopathic approaches and techniques.The aim of the study: to investigate the clinical effectiveness of osteopathic techniques of gallbladder drainage.Materials and methods. The study was conducted in 2022–2023 on the basis of Polyclinic of the Federation of Independent Trade Unions of Russia (Moscow) and City Mariinsky Hospital (St. Petersburg). There were 30 people (9 men and 21 women) aged 18 to 59 years (mean age was 40,4±2,3 years) without pathology of the gastrointestinal tract and gallbladder (biliary tract) who agreed to participate in the study. All participants underwent a fasting gallbladder volume study, followed by a gallbladder volume study one hour after eating a trial breakfast (TB). One week after the first study, the same patients underwent another fasting gallbladder volume study, then a gallbladder volume study after osteopathic correction (OC) techniques. Thus two observation groups were formed: observation 1 (TB) — study of gallbladder function before and after taking a trial breakfast; observation 2 (OC) — study of gallbladder function before and after gallbladder drainage techniques. Participants did not receive other treatments during the study. All respondents underwent clinical osteopathic examination and biliary ultrasound with motor function score (MFS) was performed. Outcomes in this study were defined as changes in gallbladder size and motility.Results. No global level somatic dysfunction was identified in the study participants. Regional biomechanical disorders and separate local somatic dysfunctions were more typical for them. However, it was not possible to identify any predominant dysfunctions, as all of them were detected in single cases. After the exposure was completed, the osteopathic status was re-evaluated. The analysis showed that there were no statistically significant changes in the frequency of detection of the main somatic dysfunctions in both observations (p>0,05). In the observed respondents, no abnormalities in the basic size and volume of the gallbladder at the beginning of the study were revealed. After the conducted stimulation no statistically significant differences in gallbladder size (length and width) both within and between the observation groups were registered (p>0,05), but statistically significant dynamics was obtained in the form of gallbladder volume decrease in response to the effect (p<0,05) both when using TB and after OC. All participants were assessed with a measure of gallbladder motor function (MFS). In case of observation 1 (TB), the MFS value was 0,66±0,09 and observation 2 (OC) was 0,58±0,07, which corresponds to normal gallbladder functional activity. Compared to the use of a trial breakfast, osteopathic correction demonstrated a slightly less pronounced effect on gallbladder motor function, but these differences between the groups were not statistically significant (p>0,05).Conclusion. Osteopathic manipulations on the gallbladder and biliary tract have an effect on the gallbladder volume and motor activity comparable to the effect of the trial breakfast.
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Zhang, Miao-Miao, Chen-Guang Li, Shu-Qin Xu, et al. "Magnetic compression anastomosis for reconstruction of digestive tract after total gastrectomy in beagle model." World Journal of Gastrointestinal Surgery 15, no. 7 (2023): 1294–303. http://dx.doi.org/10.4240/wjgs.v15.i7.1294.
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Obstructive jaundice (OJ) is a common problem in daily clinical practice. However, completely understanding the pathophysiological changes in OJ remains a challenge for planning current and future management. The effects of OJ are widespread, affecting the biliary tree, hepatic cells, liver function, and causing systemic complications. The lack of bile in the intestine, destruction of the intestinal mucosal barrier, and increased absorption of endotoxins can lead to endotoxemia, production of proinflammatory cytokines, and induce systemic inflammatory response syndrome, ultimately leading to multiple organ dysfunction syndrome. Proper management of OJ includes adequate water supply and electrolyte replacement, nutritional support, preventive antibiotics, pain relief, and itching relief. The surgical treatment of OJ depends on the cause, location, and severity of the obstruction. Biliary drainage, surgery, and endoscopic intervention are potential treatment options depending on the patient's condition. In addition to modern medical treatments, Traditional Chinese medicine may offer therapeutic benefits for OJ. A comprehensive search was conducted on PubMed for relevant articles published up to August 1970. This review discusses in detail the pathophysiological changes associated with OJ and presents effective strategies for managing the condition.
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Hoshi, Hajime, and Yoshihiro Sakai. "Clinical Study on Causative Factors and Recurrence of Choledocholithiasis." Diagnostic and Therapeutic Endoscopy 3, no. 2 (1996): 81–91. http://dx.doi.org/10.1155/dte.3.81.
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To identify factors involved in choledocholithiasis, clinical characteristics were studied using univariate and multivariate analyses. Factors involved in recurrence were also investigated. The subjects consisted of 51 patients with calcium bilirubinate stones (B group) and 52 patients with cholesterol stones (C group). All patients had choledocholithiasis and underwent lithotripsy by endoscopic sphincterotomy (EST) during the past 9 years. Twenty variables, including clinical symptoms and endoscopic retrograde cholangiopancreatography (ERCP) findings, were analyzed using a Statistical Analysis System (SAS) software package. Univariate analysis were done using Student's t-test and the chi-square test. Multivariate analyses were done by stepwise logistic regression analysis. In univariate analyses, there were significant differences between the B group and C group in nine variables: age, common bile duct diameter, common hepatic duct diameter, common bile duct stone diameter, cystic duct diameter, and the presence of gallbladder stones, atypical arrangement of the hepatic duct, parapapillary diverticulum, and large parapapillary diverticulum. In multivariate analysis, the four variables of no gallbladder stone, large parapapillary diverticulum, cystic duct less than 8 mm, and atypical arrangement of the hepatic duct were significant independent factors for the development of stones in the B group, with relative risks of 37.75, 16.73, 5.56, and 5.49, respectively. The results indicated that calcium bilirubinate stones were frequently associated with parapapillary diverticulum and abnormal arrangement of the bile duct. The formation of these stones was attributed to chronic biliary stasis caused by dysfunction of the biliary tract, including the papilla. In contrast, most cholesterol stones found in the common bile duct had apparently descended from the gallbladder. Common bile duct stones recurred after EST in 9 patients, all of whom had calcium bilirubinate stones. On ERCP, recurrence was found to be frequently associated with gallbladder stones, large parapapillary diverticula, and atypical arrangement of the hepatic duct. Patients with these characteristics on initial ERCP should therefore receive appropriate treatment and undergo strict follow-up observations owing to the increased risk of recurrence caused by dysfunction of the biliary tract.
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Grinevich,, V., Yu Kravchuk, P. Seliverstov, et al. "The role of chronic systemic inflammation in the formation of functional disorders of the biliary tract." Vrach 35, no. 1 (2024): 69–73. http://dx.doi.org/10.29296/25877305-2024-01-14.
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Functional disorders of the biliary tract are included in the group of functional diseases of the digestive system, widespread everywhere, and represent a complex of clinical symptoms developing as a result of motor-tonic dysfunction of the gallbladder, bile ducts and sphincters. Their clinical manifestations are often quite diverse and non-specific. Therefore, the problem of verification, treatment and prevention of this pathology continues to be relevant. In our study, among 37 practically healthy volunteers, in 55% of cases, a functional disorder of the gallbladder of the hypomotor type was detected, correlations of indicators of the motor function of the gallbladder with markers of systemic inflammation were established.
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Chen, Xiaofeng, Deqiang Wang, Jing Liu, et al. "Genomic alterations in biliary tract cancer predict prognosis and immunotherapy outcomes." Journal for ImmunoTherapy of Cancer 9, no. 11 (2021): e003214. http://dx.doi.org/10.1136/jitc-2021-003214.
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BackgroundRecently, immunotherapy with immune checkpoint inhibitors (ICIs) has shown promising efficacy in biliary tract cancer (BTC), which includes gallbladder cancer (GBC) and cholangiocarcinoma (CHOL). Understanding the association between immunotherapy outcomes and the genomic profile of advanced BTC may further improve the clinical benefits from immunotherapy.MethodsGenomic tumor DNA was isolated from 98 Chinese patients with advanced BTC and used for targeted next-generation sequencing of 416 cancer-related genes to identify the genomic alterations common to advanced BTC. Thirty-four patients had received ICI camrelizumab plus gemcitabine and oxaliplatin (from the NCT03486678 trial) as a first-line treatment. Tumor-infiltrating immune cells were evaluated using immunofluorescence staining.ResultsKRAS and TP53 mutations were much more frequent in the advanced-stage BTC cohort than in other cohorts with mostly early stage disease. Specifically, KRAS-TP53 co-mutations were favored in advanced CHOL, with a favorable response to immunotherapy, while single KRAS mutations predicted poor prognosis and immunotherapy outcomes for CHOL. Compared with GBC, CHOL had more mutations in genes involved in KRAS signaling; a high mutation load in these genes correlated with poor immunotherapy outcomes and may subsequently cause inferior immunotherapy outcomes for CHOL relative to GBC. Furthermore, a genomic signature including 11 genes was developed; their mutated subtype was associated with poor prognosis and immunotherapy outcomes in both CHOL and GBC. Transcriptome analyses suggested immune dysfunction in the signature mutated subtype, which was validated by tumor microenvironment (TME) evaluation based on detection of immune cell infiltration. Importantly, the signature wild-type subtype with favorable TME may be an advantageous population of immunotherapy.ConclusionsGenomic alterations in advanced BTC were associated with specific prognosis and immunotherapy outcomes. Combining genomic classification with TME evaluation further improved the stratification of immunotherapy outcomes.
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Kravets, O. V., V. V. Yekhalov, and V. V. Gorbuntsov. "Pathophysiology of the gastrointestinal tract in burn disease." General Surgery, no. 2 (June 30, 2024): 75–84. http://dx.doi.org/10.30978/gs-2024-2-75.
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The review of foreign publications resulted in a generalisation of medical reports on the pathological changes of the gastrointestinal tract in burn disease. Burn disease produces an immediate reaction in all organs and systems, which are not always able to maintain homeostasis and frequently suffer pathophysiological and morphological damage. One of those target systems is the gastrointestinal tract. Only in very rare cases do severe (mainly electrical) burns cause direct injury to the abdominal cavity organs, thus resulting in a very severe clinical course and high mortality. Patients of all ages who have experienced a burn injury have an increased overall risk of developing gastrointestinal diseases, which include pathology of the esophagus, stomach, and intestines, as well as lesions of the gallbladder, biliary tract, and pancreas. With a burn area of 40—95%, 5.7% of the victims were diagnosed with pathology of the abdominal organs. Among them, 26.0% had an abdominal catastrophe (infarction or perforation), 37.0% had bleeding from the upper parts of the gastrointestinal tract, 32.0% had paralytic intestinal obstruction, and 5.0% developed pancreatitis and acute necrotizing cholecystitis. Large burns are usually associated with a significant decrease in splanchnic perfusion. After severe burns, intestinal ischemia and hypoxia disrupt the intestinal epithelial barrier and enteric bacterial translocation, leading to serious complications such as systemic inflammatory response syndrome, sepsis, and multiple organ failure. Peritonitis or gastrointestinal bleeding accounted for 88.2% of deaths among patients with gastrointestinal dysfunction. In general, gastrointestinal dysfunction was more common in patients with inhalation injuries, burn shock, large burn areas, and high analgesic requirements.
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Yakovenko, E. P., N. A. Agafonova, A. V. Yakovenko, A. N. Ivanov, I. P. Soluyanova, and T. B. Rusheva. "Modern approaches to treatment of patients with biliary sludge: how to choose optimal scheme?" Medical alphabet 1, no. 6 (2019): 5–12. http://dx.doi.org/10.33667/2078-5631-2019-1-6(381)-5-12.
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Currently, biliary sludge (BS) is considered as a pathological process associated with an increase in the lithogenicity of bile and according to the modern classification of gallstone disease referred to the prestone stage of the disease. In the mechanism of BS formation, the main role belongs to four factors: glut of bile with cholesterol, formation of crystallization nucleus, dysfunction of the gallbladder (contraction, absorption, secretion), violation of the enterohepatic circulation of bile acids. Clinical manifestations in BS are most often associated with concomitant functional disorders of the biliary tract and chronic bacterial duodenitis with duodenal hypertension. The main directions in the treatment of BS are reduced to the restoration of the normal rheological properties of bile, the normalization of the motor function of the biliary system and the duodenum, the correction of the intestinal microbiome. The article discusses effective treatment regimens for BS depending on its morphological features and clinical course with the use of ursodeoxycholic acid or hofitol. The mechanism of Chophytol action (Mayoly Spindler, France) at BS is presented. The additional use of Meteospasmyl in the presence of intestinal antiseptic indications contributes to the rapid resolution of clinical manifestations in this pathology.
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Malevannaya, V., E. Alymbaev, and O. Atykanov. "Evaluation of Treatment of Biliary Tract Dysfunction in Children by the Activity of the Cytokine System." Bulletin of Science and Practice 6, no. 7 (2020): 133–38. http://dx.doi.org/10.33619/2414-2948/56/15.
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The study presents data on the examination of 100 children aged 7 to 14 years with a disturbance of the motor-evacuation function of the bile excreting system in the hypomotor type (57 children — I clinical group) and hypermotor type (43 children — II clinical group). As a control group, 20 somatically healthy children were examined. It was shown that with hypomotor dyskinesia of the gallbladder, the activity of the cytokine (interleukin) system in the blood plasma was significantly superior to activity in hypermotor dyskinesia. Combined therapy in children’s second clinical group leads to normalization of blood levels of interleukins, whereas the children of the first clinical group stored in elevated blood concentrations of interleukin closure during treatment.
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Date, Yuko, Toshinobu Hayashi, Hiroaki Shimizu, Tatsuru Tomizawa, and Takanori Kobayakawa. "Gemcitabine Induced Bone-marrow Suppression in Pancreatic or Biliary Tract Cancer Patients with Moderate Renal Dysfunction." Iryo Yakugaku (Japanese Journal of Pharmaceutical Health Care and Sciences) 39, no. 3 (2013): 174–81. http://dx.doi.org/10.5649/jjphcs.39.174.
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Tay, Fatih, Mustafa Büyükkör, and Ayşe Duran. "Factors contributing to survival in hepatic dysfunction due to colorectal cancer." Srpski arhiv za celokupno lekarstvo, no. 00 (2022): 97. http://dx.doi.org/10.2298/sarh220725097t.
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Introduction/Objective. Colorectal Cancer(CRC) is currently the third most common cancer in incidence in the United States and accounts for about 8,5% of all cancer related deaths. Our study aimed to determine the parameters that contribute to the survival of CRC patients with hepatic dysfunction, attention to the positive effects on survival when the most appropriate clinical approaches. Methods. Patients with CRC, diagnosed with hepatic dysfunction, and who were followed up in our inpatient service in the last two years were included in our study. Survival rates were analyzed starting from after the development of hepatic failure. Results. A total of 57 patients were included in the study, 44 (77.2%) were colon carcinoma, and 13 (22.8%) were rectal carcinoma patients, and 14 (24.56%) were female. Bile Duct Dilatation (BD) was detected in 19 (33%) of 57 patients with imaging methods. The median OS was calculated as 4.0 vs. 1.4 months in patients with BD compared to patients without dilatation (p < 0.001). Survival times were significantly higher in patients with biliary tract dilatation compared to those without dilatation, and in patients without renal failure compared to those with renal failure. Conclusion. In cancer patients with hepatic dysfunction, those with additional renal failure had shorter survival times and a worse prognosis. The longer survival of patients with bile duct dilatation was attributed to the optimal timing of the Percutaneous Transhepatic Cholangiography (PTC) insertion, close clinical and inflammation marker follow-ups, and early prevention of external biliary drainage, therefore preventing a possible septic complication early on.
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Hosty, Jennifer, Ruth Narramore, Matthew Boothroyd, and Rekha Ramanath. "Diagnostic complexity in the older patient: an unusual presentation of advanced biliary disease." Age and Ageing 50, no. 5 (2021): 1859–60. http://dx.doi.org/10.1093/ageing/afab123.
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Abstract Biliary disease is common in the older population, and gallbladder dysfunction and increased bile lithogenicity predispose to calculi formation. This case demonstrates an unusual presentation of gallbladder empyema. A 90-year-old male with metastatic prostate cancer presented with hypoactive delirium. With no localising features, normal liver function tests but persistently raised inflammatory markers, he was initially managed as a urinary tract infection. Chest wall discomfort and swelling over the right costal margin later developed. Abdominal imaging demonstrated a massive gallbladder empyema invaginating through the lower right rib cage, causing the superficial swelling. Pre-morbid status prevented cholecystectomy and he was managed conservatively with percutaneous cholecystostomy and antibiotics. He was discharged to 24-h care 2 weeks after diagnosis with a long-term drain.
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Wu, Zhen, Zhi-Gang Zhou, Ling-Yu Li, Wen-Jing Gao, and Ting Yu. "Optimal choice of stapler and digestive tract reconstruction method after distal gastrectomy for gastric cancer: A prospective case–control study." World Journal of Gastrointestinal Surgery 15, no. 7 (2023): 1354–62. http://dx.doi.org/10.4240/wjgs.v15.i7.1354.
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Obstructive jaundice (OJ) is a common problem in daily clinical practice. However, completely understanding the pathophysiological changes in OJ remains a challenge for planning current and future management. The effects of OJ are widespread, affecting the biliary tree, hepatic cells, liver function, and causing systemic complications. The lack of bile in the intestine, destruction of the intestinal mucosal barrier, and increased absorption of endotoxins can lead to endotoxemia, production of proinflammatory cytokines, and induce systemic inflammatory response syndrome, ultimately leading to multiple organ dysfunction syndrome. Proper management of OJ includes adequate water supply and electrolyte replacement, nutritional support, preventive antibiotics, pain relief, and itching relief. The surgical treatment of OJ depends on the cause, location, and severity of the obstruction. Biliary drainage, surgery, and endoscopic intervention are potential treatment options depending on the patient's condition. In addition to modern medical treatments, Traditional Chinese medicine may offer therapeutic benefits for OJ. A comprehensive search was conducted on PubMed for relevant articles published up to August 1970. This review discusses in detail the pathophysiological changes associated with OJ and presents effective strategies for managing the condition.
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Guryleva, E. N. "Clinical observation of the patient with monolobar form Caroli disease." Experimental and Clinical Gastroenterology, no. 3 (March 19, 2024): 149–53. http://dx.doi.org/10.31146/1682-8658-ecg-223-3-149-153.
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Objective. To demonstrate a case of a rare congenital liver disease, Caroli disease, characterized by segmental non-obstructive fibrocystic dilatation of the intrahepatic bile ducts. Main points. Caroli disease was first described by the French doctor Jacques Caroli in 1958. There are 2 types of Caroli disease: True type with dilation of the intrahepatic bile ducts, usually affecting one segment and with a tendency to form stones and develop cholangitis. The second type, which is combined with congenital hepatic fibrosis, polycystic kidney disease and is more common than the true type. When the disease is accompanied by CHF, it is called Caroli syndrome or Grumbach disease. It is important to remember about Crowley’s disease and include it in the differential range of diseases of the biliary tract and liver, such as cholangitis, secondary biliary cirrhosis, portal hypertension of unknown etiology, cholangiocarcinoma. Conclusion.The diagnosis of Caroli disease and Caroli syndrome is made using imaging studies. Treatment is largely supportive and should be individualized, with prognosis depending on the severity of the disease and the presence of concomitant renal dysfunction.
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Privorotsky, Valery F., and Natal’ya E. Luppova. "Pancreatic type dysfunction of oddi sphincter in children." Pediatrician (St. Petersburg) 7, no. 3 (2016): 111–16. http://dx.doi.org/10.17816/ped73111-116.
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Anatomical and functional characteristics of the pancreas and its close relationship to adjacent organs, primarily duodenum and biliary tract, cause its frequent involvement in pathological process. Difficulties in differentiation of functional and organic pathology of the pancreas are associated not only with the difficulties of diagnostic of functional diseases, but also with the problems of classification and definitions. As to realities of today optimal version is one proposed by the authors of ICD 10 and found further development in the materials of the Rome III consensus - namely the Oddi sphincter dysfunction in pancreatic type. Under this diagnosis there is the possibility for logical explanation of involvement of pancreas in pathological process. The article also describes the diagnostic criteria for the Oddi sphincter dysfunction in pancreatic type, which includes clinical, laboratory and instrumental signs. It is noted that the recommended set of instrumental examination in modern pediatric practice is not only unimplementable, but just is not necessary. The usefulness of the recommended methods (including procedures that are potentially dangerous in terms of developing pancreatitis) for functional disorders is discussing. In the article the issues of nutrition of children with diseases of the pancreas, as well as the program of medical correction of dysfunction of the sphincter of Oddi in pancreatic type, are described.
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Neuman, Manuela G., Stephen Malnick, and Lucy Chertin. "Gamma glutamyl transferase – an underestimated marker for cardiovascular disease and the metabolic syndrome." Journal of Pharmacy & Pharmaceutical Sciences 23, no. 1 (2020): 65–74. http://dx.doi.org/10.18433/jpps30923.
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Gamma glutamyl transferase (GGT) is an enzyme in glutathione and cysteine metabolism. GGT is a standard liver enzyme test reflecting biliary tract involvement. It also has a prooxoidant activity and a modulating influence on endothelia dysfunction. GGT is associated with the metabolic syndrome and is often elevated in patients with NAFLD.
 There is also a role for GGT activity in several aspects cardiovascular disease. There is an association between elevated GGT and cardiovascular mortality, atrial fibrillation, exacerbation of congestive heart failure . In addition there is an association with obstructive sleep apnea.
 We review the evidence available and suggest that there is a need for further assessing the use of GGT, together with the presence of the metabolic syndrome as a prognostic marker.
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Shibata, Takashi, Tomoki Ebata, Ken‐ichi Fujita, et al. "Optimal dose of gemcitabine for the treatment of biliary tract or pancreatic cancer in patients with liver dysfunction." Cancer Science 107, no. 2 (2016): 168–72. http://dx.doi.org/10.1111/cas.12851.
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Shah, Nakul Manish, Quentin Kimana, Lianchun Xiao, et al. "Multimodal evaluation of metabolic dysfunction–associated steatotic liver disease (MASLD)–related biliary tract cancer (BTC) and immunotherapy outcomes." Journal of Clinical Oncology 43, no. 16_suppl (2025): 4091. https://doi.org/10.1200/jco.2025.43.16_suppl.4091.
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4091 Background: Rising incidence of BTC, particularly intrahepatic cholangiocarcinoma (iCCA), may be linked to increasing incidence of obesity, MASLD and type 2 diabetes mellitus (T2DM). Immunotherapy with immune checkpoint inhibitors (ICIs) has modestly extended survival in biliary tract cancer. However, the prevalence of MASLD in BTC, its immune microenvironment (TME) and outcome of MASLD-BTC with ICIs are unknown. Methods: Retrospective analysis of BTC patients (pts) treated with ICI between 5/2021-5/2024 with durvalumab, cisplatin, and gemcitabine. We used American Association for Liver Diseases (AASLD) criteria for MASLD: 1) metabolic dysfunction and 2) steatosis on imaging or biopsy. We calculated liver proton-density fat fraction (PDFF) in pre-treatment non-contrast CT scans (PDFF estimate 5% labelled as steatosis). We examined the statistical association between BMI and both tumor genotype and gene expression patterns using data from institutional genomic platforms (MAPP2 and RTI). Results: 179 BTC pts (65% of whom were iCCA) treated with durvalumab, cisplatin, and gemcitabine, 103 (57.5%) met AASLD MASLD criteria. In evaluable pts, the median overall survival (OS) was 18.4 months, and median follow-up time was 16.7 months. Non-MASLD pts had a median OS of 23.0 months (95% CI: 16.2, NA) versus 16.7 months (95% CI: 12.4, 21.2) with MASLD (p = .056). T2DM was associated with a worse OS (10.6 versus 21.2 months, p = .004). Multivariable cox model for OS demonstrated a hazard ratio (HR) of 1.45 (95% CI: 0.87, 2.4; p = .1564) for MASLD and 1.61 (95% CI: .99, 2.65; p = .0575) for T2DM. The median progression-free survival (PFS) was 8.5 months. MASLD BTC had a median PFS of 8.2 months (95% CI: 5.7, 10.1) versus 9.2 months (95% CI: 6.9, 16.2) without MASLD (p = .459). BTC pts with T2DM had median PFS of 5.8 months vs 13.0 months without T2DM (p = .001). Multivariable cox model for PFS had HR of 1.7 (95% CI: 1.1, 2.6; p = .014) for T2DM. Within our institutional database (n = 919), we observed depletion of KRAS (p = .008) and STK11 (p = .02) mutations in BTC pts with high BMI. RNA-seq (n = 77) suggests that elevated BMI was associated with low expression of pan-immune and epithelial-to-mesenchymal transition and increased expression of oxidative phosphorylation signatures. Conclusions: BTC is commonly associated with MASLD and may correlate with reduced OS and PFS with ICI, particularly in T2DM pts. Our findings suggest a distinct immunogenomic signature in MASLD-BTC and highlight the importance of further investigating the TME in this population.
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Pokidko, Mariya I., Igor M. Vovchuk, and Oleh A. Yarmak. "RESULTS OF ACUTE PURULENT CHOLANGITIS TREATMENT WITH GENETIC ENGINEERING ANALOGUE OF DORNAZE-ALPHA NATURAL ENZYME." Wiadomości Lekarskie 73, no. 9 (2020): 1973–76. http://dx.doi.org/10.36740/wlek202009214.
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The aim: To evaluate the effectiveness of the proposed method of surgical treatment of patients with acute purulent cholangitis. Materials and methods: The research is based on the analysis of the treatment results in 104 patients with acute purulent cholangitis. The volume of surgical interventions on the biliary tract in patients was as follows: endoscopic papillosphincterotomy (EPST) + naso-biliary drainage; EPST + laparoscopic cholecystectomy; cholecystectomy + choledocholithotomy + drainage of the common bile duct. Results: The APACHE-2 scale assessment for patients in the control group was 12,80 ± 1,73, with the SOFA scale - 4,32 ± 0,31 points. Accordingly, the assessment for patients in the main group with the APACHE-2 scale is 11.76 ± 0.81, with the SOFA scale - 4.33 ± 0.79 points. The results obtained in both the control and the main group indicate that the physiological reactions of the organism to the disease, treatment, development of organ dysfunction are reflected in the integrated severity assessment scales. Conclusion: The performed analysis of clinical and laboratory results of treatment in both groups established the high efficiency of the proposed treatment method in patients with acute purulent cholangitis, which promotes the more rapid medical and social rehabilitation in this category of patients.
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Berezneva, Nataliya A., Olga I. Stenina, and Andrey K. Uglitskikh. "Differentiated approach to the examining children with chest pain." Russian Pediatric Journal 24, no. 1 (2021): 20–26. http://dx.doi.org/10.46563/1560-9561-2021-24-1-20-26.
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The aim of this work is to determine the causes of chest pain in children with combined pathology and to develop an examination algorithm for chest pain. Materials and methods. Examined 20 children aged 7-18 years who consulted a pediatrician with pain complaints in the chest. To exclude the cardiac genesis of pain, all patients underwent electrocardiography and echocardiography; the rest of the examinations were prescribed, taking into account the anamnesis and clinical examination data. Results. According to the examination results, most patients were found to have gastrointestinal tract pathology: gastroesophageal reflux disease, chronic gastritis, biliary tract dysfunction. Against the background of adherence to a diet and taking medications prescribed by a gastroenterologist, their pain syndrome subsided, which confirmed the noncardial genesis of thoracalgia. A clinical analysis of cases of combined (cardiac and non-cardiac) pathology was carried out, an algorithm for examining children with chest pain was presented. Discussion. The causes of chest pain in children and the tactics of managing these patients are discussed, the clinical significance of the history and clinical examination data in drawing up a plan for the examination of such patients is determined.