Eremina E.Yu., Zvereva S.I. and others. Treatment of patients with gastroesophageal reflux disease. Have all the issues been resolved? // Clinical perspectives of gastroenterology, hepatology.” 2015. No. 5.

Pharmacological properties of the drug Ursosan

Ursodeoxycholic acid has a membrane-stabilizing and hepatoprotective effect, protecting hepatocytes from damaging factors. It has immunomodulatory activity, reduces the severity of immunopathological reactions in the liver by reducing the expression of histocompatibility antigens HLA-1 on hepatocytes and HLA-2 on bile duct cells and reducing the effect of immunoglobulins (primarily IgM). Reduces the formation of cytotoxic T-lymphocytes. By stimulating exocytosis in hepatocytes during cholestasis by activating Ca2+-dependent α-protein kinase, ursodeoxycholic acid reduces the concentration of bile acids toxic to hepatocytes (cholic, lithocholic, deoxycholic, etc.). Inhibits the absorption of lipophilic bile acids in the intestine (apparently due to a competitive mechanism), increases their fractional turnover during the hepatic-intestinal circulation; induces choleresis with a high content of bicarbonates, which leads to an increase in the passage of bile and stimulates the excretion of toxic bile acids through the intestines. By replacing non-polar bile acids, it forms non-toxic mixed micelles. By reducing the synthesis of cholesterol in the liver, as well as its absorption in the intestine, ursodeoxycholic acid reduces the lithogenicity of bile, reduces the cholate-cholesterol index, promotes the dissolution of cholesterol stones and prevents the formation of new ones. Absorbed in the small intestine by passive diffusion, and in the ileum by active transport. The maximum concentration in the blood plasma after oral administration is reached after 0.5–1 hour. 96–99% binds to blood plasma proteins. The therapeutic effect of the drug depends on the concentration of ursodeoxycholic acid in bile. About 50–70% of the total dose of the drug is excreted in the bile. In the intestine, it is partially broken down to lithocholic acid, which, during enterohepatogenic circulation, enters the liver and is retransformed into cheno- and ursodeoxycholic acids.

Choleretic Ursosan - reviews

Good man

Negative effect. I took it for three days. The pricking started on the right side, my stomach hurt, I hope gastritis hasn’t started again, because I just finished treating it. It was prescribed by a gastroenterologist, I have tract dyskinesia, no stones. Cholesterol is high for a 20 year old. I wanted to get rid of the pain of cholecystitis, but it didn’t work. As you can imagine, these were more painful. And sharp. I do not advise. Let them immediately in the hospital prescribe normal medications or not prescribe anything at all, but not this. I started feeling nauseous and couldn’t sleep at night because of this miracle.

Eugene

I didn’t have a very good liver test (ALAT) and they prescribed Ursosan. To my disappointment, after two weeks the liver ALAT got worse. It’s not clear? I won’t take it anymore. I feel sorry for the money and my health. Maybe it’s just that?

Denis

A bad drug, it didn’t help anything, before treatment with this drug nothing hurt, then intestinal disorders and severe pain appeared

—

Very bad drug causes severe pain

Faith

I had my gall bladder removed, was prescribed to take Ursosan, took it for three years, then pain on the right side began to appear periodically. The doctor advised to replace the drug with an analogue - Ursodez. Apparently, during the process of taking it, something in the body changed and an intolerance to something in the composition of Ursosan appeared.

Nekrasova Elena

Negative. I have biliary dyskinesia, an ultrasound showed the presence of small stones in the gall bladder, the doctor advised using Ursosan to dissolve cholesterol stones. I took Ursosan in the form of 2 capsules at night. After some time I noticed a sharp increase in pressure to 150/70, although I have been hypotensive throughout my life and my normal blood pressure is low, in the range of 110-120, my condition was disgusting, I started taking medication for my blood pressure, and after stopping Ursosan, my blood pressure immediately returned to normal. The doctor agreed with stopping Ursosan.

Galina

The doctor prescribed the drug for me, I have cholesterosis, 3 drops at night, after 2 weeks of taking it, my hemorrhoids were restored

Elena R

https://instrukciya-otzyvy.ru/292-ursosan-po-primeneniyu-analogi-kapsuly-tabletki-gepatit-zheltuha-zabolevaniya-pecheni.html

After two weeks of taking it, my hair began to fall out in batches. At first I didn’t know what to think, then I read about the side effects. Before buying the whole course, I should have tried it on a small package, now it’s lying around in the cabinet.

albordub

https://www.medkrug.ru/medicament/show_opinion/346

I was diagnosed with Cholesterosis (2 small polyps 1 and 2 mm), Ursosan was prescribed, 1 drop. in the evening after eating.

When taking it on the 3rd day, an allergic reaction began: redness of the face, tingling, burning of the eyelids, by the evening the joints began to ache, the medication had to be stopped. The doctor recommended taking Eubicor or Rekitsen-rd in parallel, which should relieve side effects, but I doubt it.

Marina

https://lekotzyvy.com/review.php?id=3193

Benefits: Didn't cause harm, temporarily eliminated problems

Flaws:

Price, does not eliminate the cause of the disease, the effect disappears after stopping use

I bought an expensive drug, full of hopes that I would finally get rid of the problems with cholestasis forever! Yeah, it's not like that. At first, everything went well - after two or three weeks of taking it, the jaundice disappeared, the pain in the right hypochondrium also disappeared, the indigestion stopped bothering me, the stool returned to normal, in general, everything was fine. I drank for a month, well, I think that’s all, I won’t need any more treatment. What a disappointment I was when, after stopping the drug, not even two weeks had passed, when the characteristic pain made itself felt again - at first it was very weak, and then began to intensify. I started drinking Ursosan again, this time I drank for 4 months (I thought I didn’t drink for long the first time, but it didn’t help at all). Everything got better for me again, while I was drinking, I had no problems. But as soon as I stopped taking it, everything started again! What does it mean? This means that the drug does not restore the liver itself, but simply temporarily removes bile, and that’s all. Well, since the source of the problems is not eliminated, the disease will still return, so why spend so much money for such an effect?

Inessa

https://lekotzyvy.com/review.php?id=3195

Advantages: Affordable

Flaws:

Cost, did not help, caused side effects

I still don’t understand how it can help with biliary reflux esophagitis, but I didn’t argue with the doctor and started drinking. It is very easy to check the effectiveness of the drug for my illness - when the acid belching, flatulence, stomach pain stop and the constant bitterness in the mouth disappears - then we can assume that the drug has helped. But in the case of Ursosan, I didn’t expect this - not that all this did not disappear, at least it didn’t even become weaker! But I didn’t drink it for a couple of weeks, or a couple of months—I took everything prescribed for six months! I kept believing that it would help, I believed the doctor’s assurances, and I spent a lot of money. In addition to wasting money, there was another problem - after 3 months or so, I periodically began to experience severe constipation, which then suddenly gave way to diarrhea. It turned out that these were side effects from Ursosan, and not errors in nutrition. In general, I spent the money and did not get any benefits, and my intestines were upset - I will not advise anyone.

lom601

https://razuznai.ru/ursosan.html#comment-20074

Ursosan-6 months. 15 tons of treatment down the drain, not a single stone has shrunk by an ounce, the head doctor said that he has never met a person whose stones dissolved from ursosan!!!

Save your money!!!

HEALTH TO THE SICK!

A CURSE TO PHARMACEUTICALS AND SCAMMERS

They will only try to get money from sick people so that you are empty and the stones do not pass you by

Guest

https://www.medsovet.info/herb/15516#post159100

I have thickened bile. I was prescribed Ursosan 2 tablets at night. After 3 days of treatment, I had a leak of bile into my stomach and now gastritis has begun. I feel nauseous all the time and can’t eat anything. This is how Ursosag treated one thing and got another sore!

Nikolay S.

https://protabletky.ru/ursosan/#otzivi

I have biliary dyskinesia. I contacted a gastroenterologist and she prescribed me this drug. Considering the price of other drugs, it is terribly expensive. But that’s not so bad, this “Ursosan” is not effective, it may have helped someone, but not me. And I took the medicine for about four months, and this is taking into account the fact that I still do not have stones in the gall bladder, but only thickening, the content of an echo suspension, and the instructions say that it even crushes the stones. In general, when I took it I hoped it would help, but it only made me sick. I still haven't solved my problem. Just like that! Now I'm drinking choleretic herbs. Hope it helps.

ytipyti

https://irecommend.ru/content/khuzhe-mne-eshche-ne-bylo-nikogda

Advantages:

- didn’t find it

Flaws:

expensive, terrible nausea as a side effect, large tablets with an unpleasant odor and taste

Oh, now I’m writing and shuddering from the “pleasant” memories. This fall, an unpleasant thing happened to me again - an exacerbation of biliary dyskinesia. Hypomotor type, biliary sluggishness, round-the-clock dull aching pain, nausea, taste in the mouth. In general, it’s not very pleasant. The gastroenterologist prescribed it along with the rest of the course of treatment, as there was stagnation on the face. According to the ultrasound, everything is clear, there are no stones, but the bend in the gallbladder has not gone away.

The first shock was a visit to the pharmacy. A box of one hundred pieces cost about 1,500 rubles. I carried it like crystal all the way home through the icy conditions. Suddenly, what, one and a half pieces))).

The second shock was reading the annotations and side effects.

The third shock came in the morning. Vomit. Unceremonious vomiting. All day down the drain. I convinced myself that I was not dying and that this was temporary, but I felt bad all day. The nausea did not go away and stood in a lump in my throat. I finally decided to take a proven anti-nausea medication, but it didn't help.

I lived in a fog for 4 days. Every day the heaviness in the hypochondrium increased, I wanted to sleep constantly and my condition was a vegetable one. I even forgot to take a magic capsule at night. And in the morning I didn’t feel so sick. It was then that it became clear what was going on. The box was pushed into the far corner. What should we do next with her now?)))

IN monica

https://otzovik.com/review_4014211.html

Advantages:

I couldn't rate them

Flaws:

constipation that cannot be relieved by anything

The drug was prescribed to me by a doctor with a vague diagnosis of “Functional gastrointestinal disorders”, a history of reflux esophagitis and bile duct dyskinesia.

The intake was designed for 1.5 months, 1 capsule per night. Having bought the medicine, I calculated that one capsule costs 100 tenge (20 rubles, approximately). I took 50, since the capsules are packed in blisters of 10 pieces.

To judge objectively the work of a particular medicine, tests and examinations are needed “before” and “after”. Frankly, neither one nor the other was prescribed to me, but I am writing this review to highlight a side effect that almost drove me crazy

Although the “side effects” section is classified as rare, in my case, it was so apt! I highlighted two manifestations that I noticed in myself, but the nausea did not torment me much. Usually I started feeling nauseous almost immediately after taking the pill, but I quickly fell asleep and didn’t feel anything.

But I was overcome with intestinal problems. Moreover, I didn’t immediately figure out how to connect constipation and Ursosan. After suffering for a month (!), I thought to look at the instructions and voila! Having immediately stopped Ursosan, my intestines began to “thank me”.

So, dears, if you have problems with regular bowel movements, ask your doctor how to deal with this while taking Ursosan. Although neither Duphalac, nor magnesia, nor water, nor laxative food helped me, but ONLY withdrawal!

Use of the drug Ursosan

To dissolve gallstones, as well as in the treatment of acute and chronic liver diseases, Ursosan is used at a dose of 10 mg/kg per day without interruption for a long time.

The duration of taking Ursosan to dissolve cholesterol gallstones ranges from 6 months to 2 years. If after 12 months from the start of taking Ursosan there is no reduction in gallstones, it is not advisable to continue treatment. When treating biliary reflux gastritis, the drug is prescribed 250 mg once a day before bedtime. The duration of treatment is usually 10–14 days. When treating cholestatic syndrome for different types of liver damage, the daily dose depends on the patient’s body weight. Usually this is 8–12 mg of ursodeoxycholic acid per 1 kg/day, that is, 500–700 mg (2–4 capsules).

The maximum daily dose is 1500 mg (6 capsules). The duration of treatment for chronic liver diseases can range from several months to 2 years. For children over 3 years of age, dosage is individual - it is recommended to prescribe 10–20 mg/kg/day. The capsules are swallowed without chewing, washed down with a sufficient amount of water.

Indications for use

Ursosan 250 mg capsules instructions for use focus on this; they should be taken only after consultation with a doctor. Only a specialist can determine the presence of indications for treatment with the drug and select the optimal regimen of use based on the patient’s condition.

Most often, Ursosan, whose price is affordable, is prescribed to maintain health in uncomplicated gallstone disease. Ursodeoxycholic acid is considered an effective remedy at the initial stage of stone formation against the background of increased crystallization of organic and inorganic compounds in the gallbladder and biliary tract. Ursosan is prescribed, the instructions indicate this, in order to prevent recurrent stone formation after cholecystectomy.

Other common indications for using the drug:

• Hepatitis in a chronic form of any origin.
• Impaired liver function caused by alcohol abuse or appearing against the background of the development of non-alcoholic steatohepatitis.
• Biliary dyskinesia, characterized by decreased motility.
• Biliary reflux gastritis, when bile is thrown into the stomach of the duodenum.
• Cystic fibrosis of the liver, which is a hereditary disease.
• Primary biliary cirrhosis, which is a severe disease that is associated with scarring of the liver tissue.

Special instructions for the use of the drug Ursosan

Successful conservative treatment of cholelithiasis is possible in the presence of purely cholesterol (X-ray negative) stones with a diameter of no more than 2 cm, preserved gallbladder function; stones should not fill more than half the volume of the gallbladder. During long-term treatment (more than a month), periodically, once a month, it is necessary to determine the activity of liver transaminases, especially in the first 3 months of treatment. Unlike chenodeoxycholic acid, the embryotoxicity of ursodeoxycholic acid has not been proven. Therefore, the decision to use Ursosan during pregnancy is made by the doctor. The use of Ursosan during breastfeeding is recommended only in case of urgent need.

Diagnostics

The diagnosis is made based on specific symptoms and signs of the disease; blood tests to identify signs of liver inflammation (ALT/AST, ALP, GGT) and autoimmune process (antinuclear antibodies, smooth muscle antibodies, antibodies to the microsomal fraction of the liver and kidneys, immunoglobulins G), conduct functional tests (PTT, INR , albumin, bilirubin), differentiate AIH, viral hepatitis and other pathologies with similar symptoms, determine the type of AIH; liver biopsy, which helps to identify the presence of fibrosis and determine the extent of organ damage.

Autoimmune hepatitis is differentiated from the following diseases: alpha-1-antitrypsin deficiency, alcoholic hepatitis, hemochromatosis, primary biliary cholangitis, primary sclerosing cholangitis, non-alcoholic fatty liver disease, viral hepatitis, Wilson's disease.

Treatment of autoimmune hepatitis

The main goal of treatment for AIH is to slow the progression of the disease associated with immune-mediated destruction of healthy liver cells. Patients are prescribed immunosuppressive therapy (artificial suppression of immunity) - glucocorticosteroids (prednisolone). Since the use of such drugs is often associated with serious side effects, the high initial dose of the steroid is gradually reduced, reducing to the minimum possible when remission is achieved. Most patients with AIH take immunosuppressive drugs throughout their lives, since refusal of therapy is associated with a high risk of relapse (more than 80%).

Reducing the side effects of prednisolone is also achieved by adding the cytostatic drug azathioprine to steroid monotherapy.

Patients are advised to lead a healthy lifestyle, eat right, normalize weight and pay attention to physical activity.

Early diagnosis and timely treatment play a key role in achieving positive results in the treatment of AIH.

If there is no therapeutic response, the patient is offered liver transplantation.

Features and advantages of treatment of autoimmune hepatitis at the Rassvet Clinic

Dawn hepatologists diagnose and treat not only common liver diseases, but also specialize in rare diseases and syndromes of the digestive system. Our doctors do not prescribe unnecessary tests and drugs with unproven effectiveness; they carry out treatment only according to international protocols.

We will definitely establish the nature of the rare disease, prescribe the necessary diagnostic tests, conduct effective drug therapy (if possible in your case), and offer effective symptomatic and supportive therapy.

Author:

Amelicheva Alena Aleksandrovna medical editor