Overlap of gallbladder dysfunction and irritable bowel syndrome: clinical and microbiological features and therapeutic possibilities

Objective — to analyse the clinical and microbiological features in patients with an overlap between gallbladder dysfunction (GBD) and irritable bowel syndrome (IBS) and a complex assessment of the effectiveness and safety of using ursodeoxycholic acid (Ursis) in these patients. Materials and methods. Under our observation were 115 patients with the overlap of GBD and IBS aged from 19 to 52. The majority of them were women (62.6%). All patients complained of abdominal pain, mostly without clear localization or in the right hypochondrium and along the course of the large intestine. Constipation was diagnosed in 83 (72.2%) patients, and meteorism in 89 (77.4%) patients. Therefore, 62 patients with the overlap of GBD and IBS, who had abdominal pain, constipation and meteorism, were selected for further study. During the study, all patients kept a diary in which the frequency and nature of bowel movements, the severity of abdominal pain, and the degree of meteorism were recorded. All patients before and after treatment underwent an ultrasound examination of the abdominal cavity, which included the study of the contractile function of the gallbladder, the emptying coefficient of the gallbladder, the thickness and density of its wall, and the density of bile. Changes in the main bacterial enterotypes were analyzed by qRT‑PCR using primers targeting 16S rRNA. We studied Bacteroidetes, Firmicutes, Actinobacteria, as well as the content of butyrate‑producing bacteria (Faecalibacterium prausnitzii and Akkermansia muciniphila) and methanogens (Methanobrevibacter smithii and Methanosphaera stadmanae). Results. Before treatment, all patients had abdominal pain of moderate intensity (6.9±0.7 points), mostly without clear localization, constipation, with a frequency of defecation (1.4±0.5) times a week, and meteorism. Before treatment, patients with an overlap of GBD and IBS had changes in the contractile function of the gallbladder with a decrease in the emptying ratio, a thickening of the gallbladder wall and an increase in its density and bile density, as well as a disturbance of the intestinal microbiome (an increase in the number of Firmicutes, Actinobacteria and methanogenic archaea and a decrease in Bacteroidetes and butyrate‑producing bacteria). Conclusions. The use of Ursis® medication in the complex therapy of patients with a GBD and IBS overlap is effective and safe. The aplication of Ursis® led to a more pronounced positive clinical dynamics (a decrease in the intensity of abdominal pain, normalization of the frequency of bowel movements, a decrease in meteorism and an improvement in general well‑being) than in the patients of the comparison group. After treatment with Ursis® the coefficient of emptying of the gallbladder increased, the thickness and density of its wall decreased. The use of the drug Ursis® in the complex therapy of patients with the overlap of GBD and IBS contributed to the improvement of intestinal flora: an increase in the number of Bacteroidetes and butyrate‑producing bacteria (Faecalibacterium prausnitzii and Akkermansia muciniphila), and a decrease in the content of methanogens (Methanobrevibacter smithii and Methanosphaera stadmanae).