Possibilities of application of enterosorbent in combined therapy of opistorchosis patients with skin syndrome

Introduction. Diseases of the liver and biliary tract are a significant problem in the clinic of internal diseases. Opistorchiasis is one of the most frequent causes of this pathology and is one of the most widespread parasitoses in the Russian Federation.

Clinical course of this pathology is characterized by high frequency of allergic and skin symptoms. Treatment of such patients is a big problem.

Aim. To determine the effectiveness of the use of complex therapy with the inclusion of enterosorbent in patients with opisthorchiasis with skin syndrome.

Materials and methods. The study involved 92 patients with chronic opisthorchiasis, of which 38 patients were with skin syndrome and 54 individuals without skin manifestations. Diagnosis of opisthorchiasis was carried out by two methods: microscopic examination of duodenal bile and coprooscopy. All patients underwent clinical examination, a clinical and biochemical blood analysis, esophagogastroduodenoscopy, ultrasound of the abdominal organs and liver elastometry with fibrosis assessment using the METAVIR system. Skin syndrome was diagnosed by dermatologist. After etiological treatment, 38 patients with opisthorchiasis with skin syndrome underwent reconstructive pathogenetic therapy for 6 weeks, which included an antispasmodic, ursodeoxycholic acid, desensitizing drug, and enterosorbent.

Results. In patients with opisthorchiasis with a skin syndrome, the severity of clinical and laboratory manifestations was significantly higher than in individuals with parasitosis without skin syndrome. Reconstructive pathogenetic therapy of patients with opisthorchiasis with the inclusion of enterosorbent Polysorb has allowed to achieve a significant improvement in the condition of patients. Conclusion. From our point of view, the results obtained make it possible to raise the question of changing the treatment standards for patients with opisthorchiasis with skin syndrome.

1. Tsukanov V.V., Seliverstova E.V., Dogadin S.A. Lipid composition of blood serum and bile in biliary diseases in patients with diabetes mellitus. Terapevticheskiy arkhiv = Therapeutic Archive. 2005;77(2):15-18. (In Russ.). Available at: https://www.elibrary.ru/item.asp?id=9133822.

2. Tsukanov V.V., Tonkikh J.L., Bronnikova E.P, Manchuk V.T. The mechanism of normolipidemia in northern peoples. Klinicheskaya meditsina = Clinical medicine. 1999;77(2):38-39. (In Russ.)

3. Tsukanov V., Gorchilova E., Vasyutin A., Tonkikh J., Rzhavicheva O. Current principles of management in patients with opisthorchiasis. Vrach (The Doctor). 2019;(12). (In Russ.) doi: 10.29296/25877305-2019-12-07.

4. Mordvinov V.A., Furman D.P. “Ob disease,, - an underestimated danger. Nauka v Rossii = Science in Russia. 2013;195(3):15-21. (In Russ.) Available at: https://www.elibrary.ru/item.asp?id=20297276.

5. Fedorova O.S., Janse JJ., Ogorodova L.M., Fedotova M.M., Achterberg R.A., Verweij JJ. et al. Opisthorchis felineus negatively associates with skin test reactivity in Russia-EuroPrevall-International Cooperation study. Allergy. 2017;72(7):1096-1104. doi: 10.1111/all.13120.

6. Phathammavong O., Ali M., Phengsavanh A., Xaysomphou D., Odajima H., Nishima S., Kuroiwa C. Prevalence and potential risk factors of rhinitis and atopic eczema among schoolchildren in Vientiane capital, Lao PDR: ISAAC questionnaire. Biosci Trends. 2008;2(5):193-199. Available at: http://www.biosciencetrends.com/getabstract.php?vol=2&issue=5&spage=193.

7. Poynard T., Bedossa P., Opolon P. Natural history of liver fibrosis progression in patients with chronic hepatitis C. Lancet. 1997;349(9055):825-832. doi: 10.1016/s0140-6736(96)07642-8.

8. Stanghellini V., Chan F.K., Hasler W.L., Malagelada J.R., Suzuki H., Tack J., Talley NJ. Gastroduodenal Disorders. Gastroenterology. 2016;150(6):1380-1392. doi: 10.1053/j.gastro.2016.02.011.

9. Lacy B.E., Mearin F., Chang L., Chey W.D., Lembo AJ., Simren M., Spiller R. Bowel Disorders. Gastroenterology. 2016;150(6):1393-1407. doi: 10.1053/j.gastro.2016.02.031.

10. Hill P.A., Harris R.D. Clinical Importance and Natural History of Biliary Sludge in Outpatients. J Ultrasound Med. 2016;35(3):605-610. doi: 10,7863/ultra.15.05026.

11. Ko C.W., Schulte SJ., Lee S.P. Biliary sludge is formed by modification of hepatic bile by the gallbladder mucosa. Clin Gastroenterol Hepatol. 2005;3(7):672-678. doi: 10.1016/s1542-3565(05)00369-1.

12. Ilchenko A.A. Classification of cholelithiasis. Terapevticheskiy arkhiv = Therapeutic Archive. 2004;76(2):75-78. (In Russ.) Available at: https://jour-nals.eco-vector.com/0040-3660/article/view/29800.

13. Ko C.W., Sekijima J.H., Lee S.P. Biliary sludge. Ann Intern Med. 1999;130(4 Pt 1):301-311. doi: 10.7326/0003-4819-130-4-199902160-00016.

14. Ilchenko A.A., Delyukina O.V. Clinical aspects of biliary sludge. Consilium Medicum. 2007;9(7):13-17. (In Russ.) Available at: http://old.consilium-medicum.com/media/consilium/07_07/13.shtml.

15. Yakovenko E.P., Agafonova N.A., Yakovenko A.V., Ivanov A.N., Soluyanova I.P., Rusheva T.B. Modern approaches to treatment of patients with biliary sludge: how to choose optimal scheme? Meditsinskiy alfavit = Medical Alphabet. 2019;1(6):5-12. (In Russ.) doi: 10.33667/2078-5631-2019-1-6(381)-5-12.

16. Tsukanov V.V., Tonkikh Y.L., Vasyutin A.V. Recommendations for the management of patients with functional disorders of the gall bladder and sphincter of Oddi. Meditsinskiy sovet = Medical Council. 2017;(11):100-103. (In Russ.) doi: 10.21518/2079-701X-2017-11-100-103.

17. Mekhtiyev S.N., Grinevich V.B., Kravchuk YU.A., Bogdanov R.N. Biliary sludge: unresolved issues. Lechashchiy vrach = Attending doctor. 2007;(6):24-28. (In Russ.) Available at: https://www.lvrach.ru/2007/06/4535299/.

18. Portincasa P., Ciaula A.D., Bonfrate L., Wang D.O. Therapy of gallstone disease: What it was, what it is, what it will be. World J Gastrointest Pharmacol Ther. 2012;3(2):7-20. doi: 10,4292/wjgpt.v3.i2.7.

19. Sablin O.A., Ilchishina T.A., Ledovskaya A.A. Diseases of the gallbladder: possibilities of treatment with ursodeoxycholic acid drugs Methodical manual. Saint Petersburg; 2013, 34 p. (In Russ.) Available at: https://vrachirf.ru/storage/78/c7/cf/a1/93/ed/b6/4651-c00602-e6ac74.pdf.

20. Ilchenko A.A. Biliary sludge: causes of formation, diagnosis and treatment. Gastroenterologiya. Prilozheniye k zhurnalu Consilium Medicum = Gastroenterology. Consilium Medicum supplement. 2012;(2):18-21. (In Russ.) Available at: https://www.elibrary.ru/item.asp?id=22472097.

21. Minushkin O.N., Burdina E.G., Novozhenova E.V. Biliary sludge: solved and unresolved issues. Meditsinskiy sovet = Medical Council. 2018;(14):90-96. doi: 10.21518/2079-701X-2018-14-90-96.

22. Bouvard V., Baan R., Straif K., Grosse Y., Secretan B., El Ghissassi F. et al. A review of human carcinogens - Part B: biological agents. Lancet Oncol. 2009;10(4):321-322. doi: 10.1016/s1470-2045(09)70096-8.