EFFICACY OF URSODEOXYCHOLIC ACID ON THE COURSE OF BILIARY GASTRITIS DEPENDING ON HELICOBACTER PYLORI STATUS IN PATIENTS WITH CHOLECYSTECTOMY FOR CHOLELITHIS

Abstract

Introduction. Stomach cancer ranks 5th in the structure of morbidity and 3rd in the structure of mortality from malignant diseases. The most common risk factors include genetic predisposition, Helicobacter pylori infection, smoking, alcohol, abuse of salty, fried, and canned foods. Bile acids also contribute to the disruption of the mucous membrane, therefore they are a predictor of precancerous diseases of the stomach. Considering the widespread prevalence of gastric cancer and the variability of causes, it is necessary to develop therapeutic and preventive measures to reduce neoplastic processes in the gastric mucosa. Purpose of the study: to analyze the effect of ursodeoxycholic acid on the expression of cell proliferation markers in the gastric mucosa in patients with biliary gastritis after cholecystectomy for cholelithiasis. Materials and methods. The study included 100 patients with an indication for elective cholecystectomy for cholelithiasis. The average age of the examined patients was 48±10,67 years. All patients underwent fibrogastroduodenoscopy with biopsy samples taken before surgery and 6 and 12 months after cholecystectomy. Depending on the nature of the damage to the mucous membrane and the treatment provided, 3 groups were formed: Group I — 35 patients with non-biliary and HP-nonassociated gastritis + Mediterranean diet; Group II — 35 patients with biliary and HP-associated gastritis + Mediterranean diet, UDCA 10 mg/kg/day (Ursosan) for 3 months; Group III — 30 patients with biliary and HP-non-associated gastritis + Mediterranean diet, UDCA 10 mg/kg/day (Ursosan) for 3 months. A morphological study was carried out with immunohistochemical assessment of CD95, Ki67, CDX2, CD34, VEGF markers. Results. In group II, an increase in the expression of CD34 and VEGF in the body (p=0.004 and p=0.001, respectively) and antrum (p=0.019 and p=0.011, respectively) of the stomach was found in combination with an increased increase in the CDX2 marker in the antrum of the stomach (p=0.004). In group III, a decrease in the expression of endothelial markers CD34 and VEGF was detected, mainly in the cardiac (p=0.003 and p=0.001, respectively) and antral (p=0.002 and p=0.001, respectively) parts of the stomach. There was also a decrease in the expression of markers of intestinal proliferation (Ki67) and apoptosis (CD95) in the cardiac (p=0.012 and p=0.031) and antral sections (p=0.002 and p=0.018) of the stomach. Conclusion. Group II had a higher score for markers of proliferative activity and endothelial markers, which probably contributes to gastric carcinogenesis associated with the influence of pathological duodenogastric reflux and H. pylori. In group III, there was a decrease in the expression of markers of cell proliferation, apoptosis, and endothelial markers, which indicates reparative functions and is probably associated with the effects of Ursosan. Thus, eradication therapy and the use of Ursosan are important directions in treatment and prophylactic measures that affect the reduction of precancerous changes in the gastric mucosa after cholecystectomy for cholelithiasis.