Biliary sludge and gallstone disease: actual scientific and practical aspects

Author: Vladimir Vladimirovich Chernyavsky, Associate Professor of the Department of Internal Medicine No. 1 of the National Medical University named after A.A. Bogomolets


Doctors of various specialties in their practice often encounter pathological conditions that, under certain conditions, can transform into serious diseases. These include biliary sludge, which should be considered as an early manifestation of cholelithiasis (GSD). Metabolic disorders, changes in the physicochemical properties of bile, an increase in its lithogenicity and a decrease in the contractile function of the gallbladder precede lithogenesis. Therefore, the therapeutic effect on these pathogenetic mechanisms makes it possible to prevent the development of HCS. This is extremely important, because the standard of care for the disease is cholecystectomy – an operative intervention that is second only to appendectomy in terms of frequency.

The main reason for the increase in the lithogenicity of bile is a change in the ratio of its components: cholesterol, bile acids and phospholipids. Excessive concentration of cholesterol in bile leads to its thickening, as a result of which crystals of cholesterol monohydrate are formed. Settling on the walls of the gallbladder, they create conditions for the occurrence of biliary sludge. It is known that stagnation of bile in the gallbladder, according to the feedback principle, inhibits choleresis, which is characterized by a decrease in the synthesis of bile solvents (lecithin, bile acids and their conjugates). This is accompanied by an increase in the lithogenicity of bile – and, as a result, the hypomotor gallbladder cannot remove the thick contents. Therefore, there is a close correlation between the bile lithogenicity index and hypokinetic dysfunction of the gallbladder. In the future, an inflammatory component joins the stagnation of bile, this leads to the fact that the pathological process passes into the initial stage of the housing and communal services – biliary sludge (from the English “sludge” – dirt, dregs). Despite the obvious pathogenetic relationship between the biliary tract and gastrointestinal tract, such a transformation occurs only in 8-23% of patients. After the elimination of the etiological factor (for example, in women after childbirth), spontaneous regression of the biliary flow is possible. However, this does not mean that such patients do not need medical treatment at all. If during an ultrasound examination (ultrasound) the patient has signs of biliary sloughing, timely preventive measures can prevent the development of complications.

As part of the scientific and practical conference with international participation “X Ukrainian Gastroenterological Week”, which took place on September 27-28 in the city of Dnipro, the Associate Professor of the Department tells in detail about the scientific and practical aspects of the treatment of biliary sludge and housing and communal services and methods for their correction in an actual interview with our correspondent internal medicine №1 National Medical University named after A.A. Bogomolets Vladimir Vladimirovich Chernyavsky.

Prepared by Ilona Tsyupa

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