medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2024-385medsovet-8578Research ArticleЗАБОЛЕВАНИЯ БИЛИАРНОЙ СИСТЕМЫ И ПЕЧЕНИDISEASES OF THE BILIARY SYSTEM AND LIVERСнижение риска билиарного литиаза на фоне различных вариантов редукции веса при ожиренииReduction of the risk of biliary lithiasis caused by various weight reduction options in obesityhttps://orcid.org/0000-0002-6150-1808ПлотниковаЕ. Ю.PlotnikovaE. Yu.

Плотникова Екатерина Юрьевна, д.м.н., профессор кафедры поликлинической терапии, постдипломной подготовки врачей и высшего сестринского образования, руководитель курса клинической гастроэнтерологии

650022, Кемерово, ул. Ворошилова, д. 22а

Ekaterina Yu. Plotnikova, Dr. Sci. (Med.), Professor, Professor Department of Polyclinic Therapy, Postgraduate Education and Nursing Care, Head of Clinical Gastroenterology Course

22a, Voroshilov St., Kemerovo, 650029

eka-pl@rambler.ruhttps://orcid.org/0000-0001-9300-5334СухихА. С.SukhikhA. S.

Сухих Андрей Сергеевич, к.м.н., заведующий лабораторией физико-химических исследований фармакологически активных и природных соединений

650000, Кемерово, ул. Красная, д. 6

Andrey S. Sukhikh, Cand. Sci. (Med.), Laboratory of Physical and Chemical Studies of Pharmacologically Active and Natural Compounds

6, Krasnaya St., Kemerovo, 650000

suhih_as@list.ruКемеровский государственный медицинский университетРоссияKemerovo State Medical UniversityRussian FederationКемеровский государственный университетРоссияKemerovo State UniversityRussian Federation202416102024015114–124Copyright © Плотникова Е.Ю., Сухих А.С., 20242024Плотникова Е.Ю., Сухих А.С.Plotnikova E.Y., Sukhikh A.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/8578

Ожирение сегодня является серьезной проблемой здравоохранения в мире, на него приходится значительная часть расходов. Ожирение и его осложнения – инсулинорезистентность и дислипидемия – были идентифицированы как независимые факторы риска желчнокаменной болезни (ЖБ). ЖБ в основном возникает вследствие четырех причин: перенасыщения холестерином желчи, вызванного избыточной секрецией холестерина в печени вследствие генетических факторов; систолической дисфункции стенки желчного пузыря; дисфункции кишечника с избыточным всасыванием холестерина или перенасыщения холестерином, вызванного нарушением печеночной циркуляции желчи, а также ускоренного роста кристаллов холестерина и твердых кристаллов холестерина. Один из факторов риска образования камней в желчном пузыре – быстрое снижение веса (на ≥1,5 кг/нед), которое провоцирует низкокалорийная диета как основное лечение, или после бариатрической операции. Бариатрическая хирургия эффективна для лечения ожирения и его осложнений, однако она не снижает заболеваемость желчнокаменной болезнью. Напротив, многие исследования показали, что бариатрическая хирургия может увеличить заболеваемость желчнокаменной болезнью. Быстрое снижение веса вызывает мобилизацию жира, а затем повышение уровня холестерина и триглицеридов в сыворотке. С другой стороны, кишечная дисфункция вследствие бариатрической хирургии сопровождается снижением уровня холецистокинина, вызывая сократительную дисфункцию желчного пузыря. Желчнокаменная болезнь требует пристального внимания после бариатрической хирургии: 10% пациентов, перенесших бариатрические операции, вынуждены подвергаться послеоперационной холецистэктомии из-за высокого риска развития желчнокаменной болезни. УДХК – природная желчная кислота, которую назначают перорально. УДХК снижает всасывание холестерина в кишечнике, усиливает биосинтез желчных кислот и снижает секрецию холестерина с желчью. УДХК является желчегонным средством, как и все желчные кислоты, но отличается от других дигидрокси-желчных кислот нецитотоксичностью. Назначение УДХК на фоне низкокалорийной диеты и после бариатрической операции значительно снижает риск образования желчных камней и холецистэктомию с сопутствующими осложнениями.

At present obesity is a major public health challenge globally, which accounts for a significant portion of all healthcare costs. Obesity and its complications, insulin resistance and dyslipidemia, have been identified as independent risk factors for cholelithiasis. Cholelithiasis is mainly caused by four factors: bile cholesterol overload caused by excess cholesterol made in the liver due to genetic factors; systolic dysfunction of the gallbladder wall; bowel dysfunction with excess absorption of cholesterol or cholesterol overload caused by impaired hepatic bile circulation; and accelerated growth of cholesterol crystals and solid cholesterol crystals. Rapid weight loss (≥1.5 kg/week) due to low-calorie diets as the main treatment method, or after bariatric surgery is one of the risk factors for gallstone formation. Bariatric surgery is effective for the treatment of obesity and its complications, but bariatric surgery does not reduce the incidence of cholelithiasis. On the contrary, many studies showed that bariatric surgery may increase the incidence of cholelithiasis. The rapid weight loss causes fat mobilization and then increases serum cholesterol and triglyceride levels. On the other hand, bowel dysfunction due to bariatric surgery is accompanied by decreased cholecystokinin levels, causing impaired gallbladder contractility. Cholelithiasis requires close attention after bariatric surgery, with 10% of patients undergoing bariatric surgery having to undergo cholecystectomy postoperatively due to a high risk of cholelithiasis. UDCA is a natural bile acid that is prescribed to be taken orally (by mouth). UDCA inhibits the absorption of cholesterol in the bowel, enhances the biosynthesis of bile acids, and reduces biliary cholesterol secretion. UDCA is a choleretic agent, as all bile acids, but differs from other dihydroxy bile acids in being non-cytotoxic. The use of UDCA while following a low-calorie diet and after bariatric surgery significantly reduces the risk of gallstone formation and cholecystectomy with associated complications.

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The authors declare that there are no conflicts of interest present.