Current perspective on the problem of cholesterol polyps of the gallbladder in patients with nonalcoholic fatty liver disease
Cholesterol pseudopolyps are the most common variant of gallbladder polyps (GP). Their development is pathogenetically connected with the components of metabolic syndrome, especially with dislipoproteinemia and nonalcoholic fatty liver disease (NAFLD). Lipid metabolism disorder in the form of increa...
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| Format: | Article |
| Language: | Russian |
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Remedium Group LLC
2022-08-01
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| Series: | Медицинский совет |
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| Online Access: | https://www.med-sovet.pro/jour/article/view/7023 |
| _version_ | 1797841903154102272 |
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| author | S. N. Mekhtiev O. A. Mekhtievа O. M. Berko |
| author_facet | S. N. Mekhtiev O. A. Mekhtievа O. M. Berko |
| author_sort | S. N. Mekhtiev |
| collection | DOAJ |
| description | Cholesterol pseudopolyps are the most common variant of gallbladder polyps (GP). Their development is pathogenetically connected with the components of metabolic syndrome, especially with dislipoproteinemia and nonalcoholic fatty liver disease (NAFLD). Lipid metabolism disorder in the form of increased levels of total cholesterol, low-density lipoproteins (LDL), decreased high-density lipoproteins (HDL), as well as steatosis and liver inflammation lead to disorders of enterohepatic circulation (EHC) of bile acids, changes in rheological properties of bile, which, eventually, can lead to uptake of excess bile cholesterol by epithelium of GP in form of micelles. Infiltration of microvilli with bile micelles causes activation of tissue macrophages and triggers subclinical microinflammation of GB wall. When neighboring microvilli, crowded with foamy cells, merge, cholesterol pseudopolyp is formed, which represents a focal form of GB cholesterosis. The main drug that influences the recovery of EHC and physicochemical properties of bile is ursodeoxycholic acid (UDCA). There is also evidence that UDCA can improve parameters of lipid metabolism, liver enzymes, reduce the severity of hepatic steatosis. The use of UDCA in patients with polyposis form of GB cholesterosis has demonstrated positive results against cholesterol polyps. Glycyrrhizic acid (GA), which has anti-inflammatory, antioxidant, antifibrotic, and other beneficial properties, can improve the effectiveness of therapy for GB polyps by acting on the subclinical microinflammation component of the GB wall. In a prospective observational study, the use of fixed combination of UDCA with GA in patients with cholesterol polyps of GB and NAFLD for 3 months resulted in reduction of polyp number and size in more than 50% of patients, which was accompanied by significant improvement of lipid spectrum and liver enzymes parameters. Further studies of UDCA+GA combination in the combination of these pathologies are required. |
| first_indexed | 2024-04-09T16:38:59Z |
| format | Article |
| id | doaj.art-5be02f3fbc174a3f8f4305e314765990 |
| institution | Directory Open Access Journal |
| issn | 2079-701X 2658-5790 |
| language | Russian |
| last_indexed | 2024-04-09T16:38:59Z |
| publishDate | 2022-08-01 |
| publisher | Remedium Group LLC |
| record_format | Article |
| series | Медицинский совет |
| spelling | doaj.art-5be02f3fbc174a3f8f4305e3147659902023-04-23T06:56:47ZrusRemedium Group LLCМедицинский совет2079-701X2658-57902022-08-01014707810.21518/2079-701X-2022-16-14-70-786285Current perspective on the problem of cholesterol polyps of the gallbladder in patients with nonalcoholic fatty liver diseaseS. N. Mekhtiev0O. A. Mekhtievа1O. M. Berko2Pavlov First Saint Petersburg State Medical University; Gastroenterology Center ExpertPavlov First Saint Petersburg State Medical University; Gastroenterology Center ExpertGastroenterology Center ExpertCholesterol pseudopolyps are the most common variant of gallbladder polyps (GP). Their development is pathogenetically connected with the components of metabolic syndrome, especially with dislipoproteinemia and nonalcoholic fatty liver disease (NAFLD). Lipid metabolism disorder in the form of increased levels of total cholesterol, low-density lipoproteins (LDL), decreased high-density lipoproteins (HDL), as well as steatosis and liver inflammation lead to disorders of enterohepatic circulation (EHC) of bile acids, changes in rheological properties of bile, which, eventually, can lead to uptake of excess bile cholesterol by epithelium of GP in form of micelles. Infiltration of microvilli with bile micelles causes activation of tissue macrophages and triggers subclinical microinflammation of GB wall. When neighboring microvilli, crowded with foamy cells, merge, cholesterol pseudopolyp is formed, which represents a focal form of GB cholesterosis. The main drug that influences the recovery of EHC and physicochemical properties of bile is ursodeoxycholic acid (UDCA). There is also evidence that UDCA can improve parameters of lipid metabolism, liver enzymes, reduce the severity of hepatic steatosis. The use of UDCA in patients with polyposis form of GB cholesterosis has demonstrated positive results against cholesterol polyps. Glycyrrhizic acid (GA), which has anti-inflammatory, antioxidant, antifibrotic, and other beneficial properties, can improve the effectiveness of therapy for GB polyps by acting on the subclinical microinflammation component of the GB wall. In a prospective observational study, the use of fixed combination of UDCA with GA in patients with cholesterol polyps of GB and NAFLD for 3 months resulted in reduction of polyp number and size in more than 50% of patients, which was accompanied by significant improvement of lipid spectrum and liver enzymes parameters. Further studies of UDCA+GA combination in the combination of these pathologies are required.https://www.med-sovet.pro/jour/article/view/7023cholesterol polyps of the gallbladdercholesterosis of the gallbladdernon-alcoholic fatty liver diseasemicroinflammationdyslipoproteidemiaursodeoxycholic acidglycyrrhizic acid |
| spellingShingle | S. N. Mekhtiev O. A. Mekhtievа O. M. Berko Current perspective on the problem of cholesterol polyps of the gallbladder in patients with nonalcoholic fatty liver disease Медицинский совет cholesterol polyps of the gallbladder cholesterosis of the gallbladder non-alcoholic fatty liver disease microinflammation dyslipoproteidemia ursodeoxycholic acid glycyrrhizic acid |
| title | Current perspective on the problem of cholesterol polyps of the gallbladder in patients with nonalcoholic fatty liver disease |
| title_full | Current perspective on the problem of cholesterol polyps of the gallbladder in patients with nonalcoholic fatty liver disease |
| title_fullStr | Current perspective on the problem of cholesterol polyps of the gallbladder in patients with nonalcoholic fatty liver disease |
| title_full_unstemmed | Current perspective on the problem of cholesterol polyps of the gallbladder in patients with nonalcoholic fatty liver disease |
| title_short | Current perspective on the problem of cholesterol polyps of the gallbladder in patients with nonalcoholic fatty liver disease |
| title_sort | current perspective on the problem of cholesterol polyps of the gallbladder in patients with nonalcoholic fatty liver disease |
| topic | cholesterol polyps of the gallbladder cholesterosis of the gallbladder non-alcoholic fatty liver disease microinflammation dyslipoproteidemia ursodeoxycholic acid glycyrrhizic acid |
| url | https://www.med-sovet.pro/jour/article/view/7023 |
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