Modern approaches to the choice of safe therapy of gallstone disease

Gallstone disease (GD) is one of the most common digestive disorders. Its prevalence among the adult population of the developed countries of Europe and North America accounts near 20% and increases annually. The significance of this pathology is stipulated by not only medical, but also social aspects due to it often defeating persons of the most working age with the high rates of temporary and permanent incapacity due to the involvement of adjacent organs in the pathological process — liver, pancreas, stomach with further progression and development of complications. The article highlights physiological mechanisms of bile formation, as well as the main reasons for the gallstone’s formation in the gallbladder. Presented the data from the recent scientific research on the role of genetic factors and gastrointestinal microbiome, as well as functional disorders of the gallbladder, sphincter apparatus and inflammation in lithogenesis. The risk factors for the GD development, the stages of its formation and clinical manifestations are discussed. The treatment of GD depends on the presence of symptoms, disease duration, development of complications, gallbladder functional state, and on the degree of damage to the liver/biliary tract. It has been shown that 25% of GD patients, who develop recurrent clinical symptoms and/or complications, require laparoscopic cholecystectomy. At the same time, patients with asymptomatic GD course, elderly polymorbid patients, as well as patients with the initial GD stages require medical treatment. Pathogenetic approaches to the GD pharmacological treatment with the use of Ursonost and Mebsyn Retard® preparations have been discussed, in particular, the mechanisms of action of the drugs’ active substances, the indications for conducting litholytic therapy, the regimen of drugs’ administration and their safety in the prevention and treatment of symptomatic GD. The principles of dietary nutrition of patients with GD and the preventive role of some products in the regulation of bile rheological properties and gallbladder contractile function have been highlighted. Though minimally invasive surgery remains the most common method of GD treatment, therapeutic treatment with the use of molecules that affect the bile rheological properties, functional state of gallbladder and biliary system, should decrease the number of gastrointestinal complications and reduce the need for cholecystectomy. Therefore, future scientific research should be focused on the development of new preventive strategies for the prevention and treatment of gallstones in the general population and especially in patients with risk factors and comorbidities.