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How is chronic cholecystitis treated?
Medical expert of the article
Last reviewed: 04.07.2025
Creating a daily routine that is rational for the child’s age, prescribing adequate nutrition, medications and non-medicinal agents are the goals of treating chronic cholecystitis in children.
During an exacerbation of chronic cholecystitis, especially with severe pain syndrome, children are hospitalized. Bed rest is prescribed, the duration of which depends on the general condition of the patient. When the exacerbation subsides, taking into account the chronic course of the disease, treatment is carried out on an outpatient basis, for example, in a one-day hospital.
Non-drug treatment of chronic cholecystitis in children
It is important to ensure sufficient sleep, time spent outdoors, physical activity, regular meals, feasible activities at school and at home. Sports competitions and abuse of audiovisual information are contraindicated for schoolchildren. It is necessary to create a friendly environment in the family, eliminate stressful situations, physical and neuropsychic overloads.
The diet should correspond to table No. 5. Food is taken fractionally (5-6 times), in small portions, at a strictly allotted time, which ensures regular emptying of the gallbladder. The ratio of proteins, fats, carbohydrates should be 1:1:4. It is important to ensure a sufficient amount of vitamins and microelements.
Canned or long-storage foods are excluded, especially meat, dairy and fish. Cold food, carbonated and tonic drinks, salty foods, spices, etc. are not allowed. Fried, fatty, spicy foods, smoked foods, sauces, pastries, ice cream are not allowed. Food allergens are not recommended: chocolate, nuts, citrus fruits, some berries and fruits, certain types of fish.
Due to the disruption of enterohepatic circulation of bile acids and disruption of digestive processes, children often suffer from constipation, which is why vegetables (carrots, pumpkin, eggplant, beetroot) and fruits (raisins, dried apricots, prunes, watermelon, melon) are recommended, which help normalize the motor function of the intestine. When prescribing a diet, it is necessary to take into account the state of the gastrointestinal tract, as well as individual intolerance to certain foods.
Drug treatment of chronic cholecystitis in children
Antibacterial drugs are prescribed only during an exacerbation of the disease. It is necessary to take into account the severity of pain and dyspeptic syndromes, changes in blood tests (leukocytosis, increased ESR), as well as the results of ultrasound or other instrumental methods. Antibiotics that accumulate in bile are used. The duration of antibacterial treatment should not exceed 10-12 days, since the side effects of antibiotics (allergy, changes in intestinal microflora, effects on the gastrointestinal mucosa) often exceed the need for complete sterilization of the bile ducts.
Sulfonamides are rarely used, as they are inferior in effectiveness to antibiotics and have an adverse effect on the liver. However, in cases of antibiotic intolerance in cases of concomitant colitis or acute diarrhea, presumably caused by salmonella, shigella, yersinia and other sensitive pathogens, sulfonamides can be prescribed in a short course (co-trimoxazole for 5 days).
For giardiasis, nitrofuran preparations (furazolidone, furaltadone, nitrofurantoin) are indicated - 2-3 courses with a break of 5-7 days. Metronidazole (Trichopolum, Klion) is prescribed to children 2-5 years old at 250 mg, 5-10 years - 375 mg, over 10 years - 500 mg in 2 doses after meals for 5-10 days.
The occurrence of neurovegetative and psychoemotional changes in the patient, “withdrawal into illness” (mainly in teenage girls) require the administration of sedatives - tazepam, rudotel, seduxen, etc.
To relieve pain, antispasmodics are used (drotaverine, platifillin, papaverine, pirenzepine). In case of hypertonicity of the sphincter of Oddi, patients may be prescribed atropine, metacin, belladonna preparations.
Choleretic agents are used depending on the characteristics of the course of chronic cholecystitis, concomitant diseases of the gastrointestinal tract. Cholecystokinetics are effective in dysfunctional disorders of the biliary tract of the hypotonic type, often combined with esophagitis, gastritis, duodenitis. Xylitol, mannitol, sorbitol, magnesium sulfate or sunflower, olive, sea buckthorn oil are prescribed. Egg yolks are considered potent cholekinetics. Cholecystokinin is considered a powerful drug.
In hypertonic dyskinesia of the gallbladder, the use of true choleretics (liobil, allochol, holenzym, etc.) is indicated, which have a positive effect on the secretory and filtration process of bile formation in the liver. In addition, the use of drugs containing bile or bile acids plays the role of replacement therapy: patients have a reduced content of some bile ingredients, including the lipid complex, cholic acid and cholesterol, which leads to changes in substrate relations in the proximal intestine and disruption of fat resorption processes. The latter circumstance significantly hinders the absorption of fat-soluble vitamins.
Synthetic drugs (oxafenamide, cyclovalone, nicodine) have choleretic properties, and when they break down into their constituent parts in the body, they have a bacteriostatic and bactericidal effect. The latter is important, given the shift of absorption processes from the proximal to the distal parts of the gastrointestinal tract, where the leading role is played by bacterial microflora.
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Traditional treatment of chronic cholecystitis in children
Herbal preparations are non-toxic, have a mild effect, have virtually no contraindications for use, and help normalize metabolic processes. These include holosas, holagol, rozanol, flamin, corn silk extract, etc. The herbal preparation gepabene contains milk thistle fruits and fumitory extract. In addition to the choleretic effect, the drug has antispasmodic and hepatoprotective effects, reduces the tone of the sphincter of Oddi. One of the pathogenetic links in the treatment of chronic cholecystitis is vitamin therapy.
In complex treatment, given the frequency of damage to the mucous membrane of the upper gastrointestinal tract, antacid non-absorbable drugs are used, mainly aluminum- and magnesium-containing drugs.
In case of violation of the exocrine function of the pancreas, as well as for normalization of cavity digestion, enzyme preparations (festal, enzistal, digestal, mezim-forte) and other drugs are recommended. Therapeutic tupages according to Demyanov with xylitol, sorbitol, 30% solution of magnesium sulfate have not lost their significance. Since children have an increase in gastric secretion and acid formation, it is advisable to prescribe slightly mineralized alkaline waters in a heated form (35-45 ° C).
Phytotherapy with the use of decoctions of chamomile, calendula flowers, buckthorn, tansy, valerian, etc. is effective. It is convenient to use the instant choleretic tea "Holaflux", which is a combination of spinach leaf extract, milk thistle fruit, silverweed herb, celandine, yarrow, licorice root, rhubarb, dandelion root and leaves, turmeric rhizomes, aloe.
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Sanatorium and resort treatment
After the exacerbation has subsided, physiotherapeutic measures are indicated, which have a warming, antispasmodic, sedative effect, increasing the formation and secretion of bile. Inductothermy, diathermy, UHF currents, and therapeutic mud are widely used. In case of gallbladder dyskinesia, electrophoresis of magnesium sulfate, papaverine, and novocaine on the liver area is indicated. Microwave and ultrasound treatment are prescribed. The use of oxygen therapy, the so-called oxygen cocktails, is pathogenetically justified. Physical therapy and massage are widely used.
Patients are recommended to undergo sanatorium and resort treatment of chronic cholecystitis no earlier than 3 months after exacerbation. Balneological resorts with mineral waters for drinking are recommended (Belokurikha, Berezovskie mineral waters, Goryachiy Klyuch, Essentuki, Zheleznovodsk, Izhevsk mineral waters, Nalchik, Pyatigorsk, Staraya Russa, Lake Shira).