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Volume 5, Issue 3, March – 2020 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

Intravenous UDCA Administration during


Cancer Chemotherapy, Liver Failure and
Oral Route not Available
Palmieri B.1,2, Vadalà M.1,2
1
Department of General Surgery and Surgical Specialties, University of Modena and Reggio Emilia
Medical School, Surgical Clinic, Modena, Italy;
2
Second Opinion Medical Network, Modena, Italy

Abstract  Conclusions:
Parenteral UDCA administration is very helpful
 Introduction: during the current chemotherapy regimens of cancer
The chemotherapy of solid primary tumors with or patients to relieve drug toxicity and help liver detox
without liver metastasis, very often impairs liver enzymes.
function causing high level of transaminase, GGT,
bilirubin, alkaline phosphatase, and low albumin level We recommend specifically intravenous treatment
due to intrinsic toxicity. The concept to add UDCA when the liver parenchyma is affected by primary or
during or after chemotherapy cycles whenever liver metastatic malignant cancers and whenever
toxicity risk is reasonably high, or impending, or gastrointestinal impairment such as obstruction or
already stabilized with variable digestive symptoms and subobstruction any level, IBD, prolonged fasting and
low life quality, is nowadays very appealing. parenteral nutrition inhibit the physiologic
enterohepatic bile acids cycle.
Unfortunately, many patients cannot tolerate the
oral prescription of full or reduced UDCA dosages I. INTRODUCTION
because of compromised digestive conditions, for gut
obstruction. Sub obstruction (from esophagus, stomach, Ursodeoxycholic acid (UDCA) is a secondary bile
duodenum down to colon) malabsorption, side effects, acid transformed by intestinal bacteria from
etc, being many people under total parenteral nutrition (cheno)deoxycholic acid, with several functions in the
(TPN) even unable to swallow fluids. control of enteric flora, ileocolic barrier integrity, lipid
absorption and metabolism. Internationally acknowledged
 Materials and Methods: and registered as a drug, it has been licensed and authorized
In a cohort of 100 patients, both sex often with for the litholytic treatment of cholesterol gallstones,
coexisting synchronous or metachronous liver primary biliary cholangitis, and other hepatobiliary
metastasis and liver enzymes/bilirubin impairment, and disorders.
very often with GI tract troubles due to oral
medications, or even problem with food absorption, and UDCA role has recently been re-evaluated as
gut transit impairment; we evaluated the possible preventive agent against damages induced by cancer
subjective/objective benefits of intravenous bile salts chemotherapy drugs, based on its anti-inflammatory,
therapy, in an plain open simple trial, whose primary antioxidant and cytoprotective activities but also as
end point was: complementary adjunct to some chemotherapy protocols
 The life quality improvement (icterus asthenia, such as sorafenib for liver cancer, due to it’s antiapoptotic
fatigue, dyspepsia, mesogastric and liver pain, (normal epithelial cells), apoptotic/autophagic properties(of
bloating, itching), cancer cells) [1].
 Control of the toxic chemotherapy symptoms and
lab exams amelioration It also inhibits cancer stem cells migration and
improves chemotherapy induced dysbiosis; specific activity
 Results: has been registered against gastric and colon cancers: in
The life quality of the treated patients was flutamide (anti prostatic cancer chemo-agent) induced
definitely improved by parenteral UDCA perfusion, hepatitis. It has been proven very effective in reducing
particularly as to the digestive symptoms and liver jaundice and restoring liver function after drug with drawl
enzymes imbalance, the tolerance was excellent, and the [2].
benefits followed up over one month.

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Volume 5, Issue 3, March – 2020 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
In another study by Ikegami and coworkers [3], procedures and unhelpful and expensive medical and
UDCA increased the apoptosis due to DNA surgical interventions [8].
topoisomerase inhibitor through a mechanism of
caspase 9 and caspase 3 activation: this is another All the patients were visited and informed during a
potential clinical support to enhance the effects of the personal interview, gave their permission, and signed an
chemo. informed consent.

II. MATERIALS AND METHODS The UDCA perfusion schedule was standardized to
3500 gr/UDCA infused each other day for a total of 10
100 patients volunteers (41 males and 59 females), sessions in 3 weeks. Nausea and vomiting were recorded
coming from the emergency Dept., aged between 30 and 80 daily on a diary card while quality of life was assessed,
years, appealed to our “Second Opinion Medical before treatment and at the end, using the Rotterdam
Consulting Network, Medical Centre (Modena, Italy), Symptom Checklist (RSCL) questionnaire. We evaluated
because of coexisting synchronous or metachronous liver asthenia, weakness, heaviness and pain in the right
metastasis and liver enzymes/bilirubin impairment, and hypochondrium biliary colics, post- prandial somnolence,
very often with GI tract troubles due to oral medications, or nocturnal insomnia, reflux, meteorism and belching,
even problem with food absorption, and gut transit constipation symptomatic hemorrhoids, itching, and skin
impairment. eruptions, dermographism. The scores given in the RSCL
Symptom Checklist are 1 (not at all), 2 (a little), 3 (quite a
The Second Opinion Medical Network is a bit), 4 (very much): the higher the score, the higher the
consultation referral web and Medical Office System symptoms intensity and poor life quality.
recruiting suddenly a wide panel of real-time available
specialists, to whom any patient affected by any disease or III. RESULTS
syndrome and not adequately satisfied by the diagnosis or
therapy can apply for an individual clinical audit [4]. Due The results showed an overall fair response of the
to the doctor-patient communication gap, most of the liver insufficiency symptoms with parenteral treatment, and
patients usually wander around the medical websites the functional lab exam markedly improved as well,
looking for proper answers to their health problems. especially transaminase, and bilirubin (TABLE 1, FIG.1).
However, their search often becomes compulsive and Albumin synthesis also was variably increased as
obsessive and often ambiguous and frustrating [5]. Palmieri expression of liver cells metabolism re-activation (FIG.2).
et al. [6] describe this borderline or even pathological The positive response to intravenous UDCA delivery was
behavior as the “Web Babel Syndrome” – a psychological observed either in the chemo-intoxicated patients, or in
imbalance affecting young and elderly patients, especially multi metastatic liver colonization and largely depended by
those with multiple synchronous diseases who receive from the amount of not invaded liver parenchyma.
their caregivers heterogeneous and misleading information
or advices, including confused, contradictory statements The life quality evaluated by the RSCL score changed
and prescriptions [7]. To deal with this problem, the Second from 0 to 4 (FIG.3).
Opinion Network aims to be a useful “problem-solving”
support revisiting each diagnostic and therapeutic step and The lab exams were improved as well paralleling the
properly re-addressing tailored treatments and prognoses, energy recovery (TABLE 1). No side effects have been
as well as preventing unnecessary investigational detected during the therapy.

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Volume 5, Issue 3, March – 2020 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
TAB.1:LIVER PARAMETERS IN PARENTERAL BILE SALTS THERAPY
N. PAT. AGE CANCER TYPE Aspartate Alanine Alkaline Total protein Gamma- Bilirubin Albumin
(yrs) transaminase - transaminas phosphatase - (g/dL), range glutamyl (mg/Dl), (g/DL),
AST (U/L), e -ALT (U/L) ALP (U/L), (6.3-7.9) transferase- range (0.1- range (3.5-
range (8-48) range (7-55) range (40- GGT (U/L), 1.2) 5)
129) range (8-61)
PRE POST PRE POST PRE POST PRE POST PRE POST PRE POST PRE POST
#1 B.L. 55 Sigmoid cancer of 2 years before. Liver 180 62 118 75 150 101 8.5 6.3 91 61 5.1 1.8 4 5
metastasis
#2 D.A. 40 Obstruction and perforation due to 150 75 102 60 168 99 8.9 6.6 93 60 4.2 1.5 3.5 5.1
colorectal cancer, colostomy. Liver
metastasis
#3 S.A. 70 Right-sided colorectal cancer (RCRC) 5 195 51 156 58 191 57 9.2 7.1 101 64 5.0 1.0 2.9 4.9
years ago. Liver metastasis
#4 T.V. 80 Esophageal cancer. Radiotherapy, 105 63 120 55 157 40 9.1 7.3 110 59 4.9 1.0 4.1 5
chemotherapy, mediastinal metastasis

#5 S.A. 51 Bladder cancer , cystectomy,peritoneal 130 79 170 43 173 71 9.3 6.8 121 63 4.4 1.1 3.7 4.8
relapse, chemotherapy
#6 M.C. 44 Ovarian cancer, lymph nodes and liver 140 24 153 52 168 52 9.4 6.4 134 67 3.9 1.4 3.4 5
metastasis
#7 O.T. 43 Gastric cancer, Krukenberg tumor 169 29 107 67 150 49 8.1 7.2 133 55 4.6 1.3 3.1 4.6

#8 B.M.G. 62 Pancreatic cancer liver diffusion 158 12 173 62 141 60 8.5 6.8 128 43 4.9 1.2 2.9 4.3
#9 B.D. 56 Gastric cancer, chemotherapy 198 14 195 30 137 54 7.8 6.9 98 41 4.0 1.6 3.1 4.8
#10 G.G. 58 Malignant centroblastic lymphoma, 110 30 109 39 120 62 8.7 7.6 99 23 4.0 1.8 2.2 3.9
high aggressive chemotherapy
#11 P.I. 61 Massive gastric cancer, chemotherapy 170 48 165 56 127 42 10.5 7.9 121 18 4.3 1.5 3.1 5
#12 A.A. 61 Synchronous breast and colon cancer 122 51 105 42 139 63 11 8.3 139 52 4.1 1.1 2.8 4.5
with biliary and liver metastasis
#13 M.G. 55 Esophageal cancer, unable to treat 178 50 179 52 167 81 9.9 7.9 141 32 4.7 1.5 3.2 4.2
with chemotherapy
#14 P.M. 55 Rectal cancer, liver metastasis 115 49 153 44 188 49 9.5 8.6 157 31 5.0 1.5 4.0 5
#15 S.E. 62 Colon Cancer , high dosage 112 73 168 47 199 96 12.5 8.2 168 29 3.9 1.2 2.5 2.9
chemotherapy

#16 B.S. 63 Carcinoma of the transverse colon, 105 57 165 51 203 72 8.8 6.3 181 13 4.9 1.3 2.9 3.7
Liver and lung metastases

#17 L.L. 31 Duodenal cancer, Krukenberg's 140 83 160 48 179 102 9.1 7.1 189 10 4.7 1.1 3.0 5
tumour, 18 Oxaliplatin therapy, high
dosage
#18 M.V. 71 Rectal cancer, colostomy, diffuse 107 53 137 69 210 113 8.7 6.9 191 29 5.0 1.1 3.1 4.8
metastasis
#19 C.G. 67 Rectal and lung cancer, liver metastasis 103 70 147 72 160 95 8.3 7.3 137 12 4.8 1.7 3.2 4.3
#20 B.N. 51 Ovarian cancer, chemotherpay, diffuse 169 87 159 40 182 126 8.2 6.8 164 31 4.7 1.5 3.9 4.9
metastasis
#21 B.D. 63 Gallbladder cancer with liver invasion 186 36 149 35 220 104 7.7 7.3 149 12 4.6 1.5 3.1 5
#22 E.E. 45 Gastric cancer 170 29 152 29 173 53 13.4 7.8 135 11 4.9 1.4 3.8 4.6
#23 G.A. 72 Colon cancer with diffuse metastasis 188 52 196 31 164 47 12.9 8.1 127 24 4.8 1.5 3.9 4.3
#24 C.D. 80 Gallbladder cancer with direct liver 105 69 193 27 137 58 11.3 7.7 110 19 5.0 1.7 4.1 5.1
infiltration
#25 M.B.A. 45 Gastric cancer + krukenberg 192 53 188 19 164 63 15.9 9.1 124 48 4.7 1.6 2.7 3.9
#26 C.C. 58 Colon and gastric cancer with liver 179 45 170 25 182 76 14.2 7.6 130 38 4.5 1.8 3.4 4.7
peripheral involvement
#27 D.A. 52 Pancreatic cancer speading into 109 83 182 58 219 88 13.1 6.7 113 42 5.0 1.2 2.8 4.1
epiploon and liver intrarterial
chemotherapy
#28 C.O. 62 Liver metastasis from colon cancer 194 76 183 62 195 51 8.9 6.2 107 18 4.9 1.2 4.00 5
#29 P.G. 43 Gastric cancer with esophageal 176 59 195 51 192 63 11.3 6.9 118 57 4.8 1.5 3.9 4.7
inoperable stricture
#30 R.S. 75 Rectal cancer with bone and liver 171 49 174 46 206 92 12.7 7.3 126 42 4.75 1.5 3.8 4.4
metastasis
#31 P.N. 47 Hodgkin lymphoma, high dose 114 92 199 42 199 78 10.4 6.9 119 37 4.99 1.7 2.9 4.8
chemotherapy toxicity
#32 T.E. 67 Gastric cancer, liver metastasis 83 42 196 39 160 49 16.2 9.3 129 22 4.56 1.7 2.5 4.3
#33 M.G. 54 Right colon, liver metastasis 75 52 189 33 152 56 12.2 9.8 108 28 4.91 1.4 3.9 4.5
#34 S.E. 61 Pancreatic cancer 69 38 142 42 173 53 11.4 9.2 98 15 5.01 1.1 2.3 4.9
#35 S.G. 69 Liver metastasis, Prostate cancer 89 42 128 52 185 57 10.7 8.5 105 11 4.96 1.5 4.1 5
#36 P.M. 80 Pancreatic cancer 58 29 111 31 196 49 9.9 8.7 94 34 4.8 1.0 3.8 4.3
#37 G.L. 73 Pancreas distal cancer, liver metastasis 108 71 108 29 157 58 10.1 7.3 112 29 4.6 1.3 2.8 4.9
#38 S.C. 80 Rectal cancer, liver metastasis 73 16 102 44 196 63 8.9 7.1 165 21 4.2 1.0 3.7 4.8
#39 A.M. 65 Ovarian cancer, toxicity by adriamicin 149 83 108 39 208 75 14.3 8.3 110 35 4.0 1.5 2.9 4.3
60mg + taxol 174.5 mg 7 kg
#40 R.E. 62 Gastric and liver metastasis 90 42 129 55 169 45 12.1 7.9 98 10 3.9 1.55 3.9 4.5
#41 P.R. 65 Pancreas cancer, biliary stent 101 39 116 62 147 49 17.9 7.7 105 55 4.5 1.5 4 5
#42 F.T. 41 Mandible cancer with infiltration of 170 95 105 67 217 79 13.3 7.3 99 58 4.9 2.7 4.1
the hypopharynx
#43 B.B. 67 Gastric cancer with liver metastasis 109 86 107 29 189 73 12.0 8.2 118 62 5.0 1.7 2.6 4.8
#44 G.V. 64 Lung cancer 168 40 128 17 197 84 11.7 7.0 137 54 4.8 1.4 3.2 4
#45 P.L 58 Left colon cancer, liver metastasis 171 29 125 35 182 59 10.4 7.4 107 46 5.0 3.3 3.9
#46 P.G. 51 Ovarian cancer, taxol + carboplat. 154 82 117 27 179 62 10.2 6.6 139 39 4.9 1.1 2.9 3.8
toxicity
#47 A.E. 62 Previous mastectomy, lung pleura and 109 71 112 63 198 79 13.4 6.2 146 17 5.0 1.2 2.0 4
liver metastasis 5 years later
#48 B.L. 69 Sigmoid cancer, lymph node and liver 107 65 195 40 206 66 11.3 6.4 102 11 4.6 1.9 3.8 4.9
metastasis
#49 P.T. 68 Rectal cancer liver metastasis 155 49 167 51 198 86 11.1 6.4 96 8 4.9 1.5 2.9 4.5
#50 A.C. 57 Ovarian metastasis, retroperitoneal 167 24 181 48 186 91 10.5 6.8 119 14 4.85 1.2 2.8 4.8
liver toxicity

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Volume 5, Issue 3, March – 2020 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
#51 M.C. 47 Metastasis from dorsum melanoma 189 38 135 39 191 72 9.9 7.1 102 58 5.3 1.5 4.1 4.5
#52 G.G. 55 Abdominal rhabdomyosarcoma with 192 45 192 20 205 79 12.1 8.0 110 42 4.9 1.8 3.9 4.1
liver infiltration
#53 M.L. 61 Esophageal cancer 143 20 165 28 178 62 11.9 7.7 98 30 5.1 1.9 2.8 4.9
#54 B.S. 63 Colon cancer 171 17 189 41 199 77 13.4 8.9 123 37 4.6 1.6 4.0 5.1
#55 B.L. 61 Liver metastases from choriocarcinoma 160 56 145 47 201 56 12.3 9.2 103 22 4.1 1.4 3.7 3.9

#56 L.L. 31 Gastric cancer + krukenberg 148 8 162 61 177 71 9.6 7.9 112 13 3.9 1.31 3.6 4.5
#57 P.M. 29 Liposarcoma liver toxicity 182 10 185 38 192 85 10.1 6.8 127 18 5.2 1.6 2.8 4.1
#58 B.F. 62 Colorectal cancer 193 24 142 33 156 92 9.8 6.2 139 21 4.8 1.2 4.1 4.9
#59 C.L. 56 Rectal cancer, liver metastasis 159 32 103 27 171 82 10.5 6.1 144 39 5.6 1 3.7 5.1
#60 A.P. 48 Gastric cancer with liver and lung 144 17 167 19 183 79 11.2 7.2 156 45 5.1 1.9 3.8 4.0
metastasis
#61 C.G. 68 Rectal cancer, peritoneal and liver 133 19 199 21 189 50 9.9 5.8 161 40 4.9 1.7 3.7 4.1
invasion
#62 C.A. 51 Liver metastases from kidney cancer 128 22 188 11 149 42 10.1 6.2 149 32 4.4 1.2 3.6 3.9
#63 P.A.M. 65 Esophageal cancer 152 34 193 19 172 57 9.9 5.9 172 26 4.6 1.52 2.9 3.5
#64 F.G. 67 Gallbladder cancer 159 38 165 26 170 62 8.8 6.9 167 29 5.7 1.9 2.8 4.1
#65 R.M. 53 Gastrectomy, subostruction 171 35 101 21 179 70 8.2 6.2 152 37 5.1 1.6 3.4 3.9
chemotherapy
#66 M.R. 57 Ovarian cancer, toxicity by adriamicin 163 41 113 38 192 61 7.9 6.3 145 42 3.8 1.8 4.1 5
60mg + taxol 174.5 mg 7 kg
#67 L.L. 62 Bladder cancer , with bone and liver 196 14 152 33 193 51 8.5 6.6 129 48 5.0 1.0 3.6 4.9
metastasis
#68 C.C. 58 Gastric Cancer 167 20 118 42 199 40 8.3 9.8 117 51 4.2 1.3 2.7 3.8
#69 S.E. 43 Gastric Cancer extended to left hepatic 173 19 127 48 178 43 7.8 6.3 114 59 3.7 1.4 3.9 4.2
lobe
#70 G.A. 72 Colon cancer, diffuse liver metastasis 187 21 131 51 188 52 8.2 6.7 137 67 4.9 1.5 3.8 4.4
#71 B.L. 68 Gastric cancer, liver metastasis 159 29 142 40 167 48 7.4 6.9 124 51 5.3 1.5 4.1 5
#72 F.B. 48 Pancreatic tail cancer, spleen and liver 104 13 151 31 178 44 7.6 6.4 99 42 4.3 1.8 3.7 4.1
metastasis
#73 G.M. 52 Pancreatic Cancer liver infiltration 116 9 167 28 188 56 6.7 7.6 105 30 5.6 1.0 3.9 4.3
#74 G.L. 71 Colon cancer, liver metastasis 129 11 182 22 160 78 6.2 6.2 129 48 3.9 1.2 3.5 4
#75 E.L. 42 Abdominal rhabdomyosarcoma, 111 27 155 18 168 62 6.9 6.1 118 56 4.1 1.81 3.4 3.9
visceral metastasis
#76 T.E. 66 Gastric cancer, liver metastasis 189 35 123 33 179 68 7.5 6.3 134 61 5.7 1.6 3.2 4.2
#77 S.L. 57 Colon cancer, liver metastasis 167 12 181 51 193 59 8.5 6.7 159 70 4.2 1.8 3.5 4.5
#78 M.L. 49 Colon cancer, liver metastasis 178 23 179 48 192 45 9.1 6.4 132 52 5.0 1.9 2.6 4
#79 C.O. 75 Adrenocortical carcinoma, liver 134 29 157 39 206 51 10.1 6.4 120 49 3.8 1.5 2.9 4.1
metastasis
#80 C.F. 61 Breast cancer, bone and liver 165 15 163 32 210 59 10.5 6.5 136 41 5.1 1.3 3.9 4.2
metastasis
#81 S.E. 60 Pancreatic cancer, stent and duodenal 181 32 128 25 209 64 9.9 6.1 151 20 4.6 1.7 3.8 4.5
infiltration
#82 G.M. 81 Gastric cancer with bowel obstruction 167 9 141 17 189 75 8.9 8.7 149 24 5.2 1.9 2.6 3.9
#83 C.N. 51 Gastric peritoneal carcinomatosis 172 12 112 39 188 82 7.5 8.2 147 19 4.5 1.5 3.9 4.6
#84 S.M. 80 Pancreatic cancer 160 45 106 26 171 44 9.3 7.0 138 16 5.0 1.45 3.7 5
#85 G.A. 37 Thyroid, colon cancer, liver metastasis 127 32 101 18 177 40 10 6.7 127 10 3.6 1.9 3.6 4.2

#86 B.B. 74 Recurrent Colon Cancer 122 28 158 12 165 46 8.0 7.2 119 23 4.1 3.6 4.5
#87 G.A. 72 Gastric Cancer extended to left hepatic 106 23 146 25 159 52 11.1 6.2 120 33 3.9 1.3 2.9 3.9
lobe
#88 M.M. 52 Ovarian cancer, toxicity by adriamicin 117 18 139 37 160 63 10.6 6.7 115 17 4.0 1.6 4 5.1
+ taxol
#89 S.M. 67 Massive gastric cancer, chemotherapy 187 11 124 48 162 65 9.10 6.9 109 28 3.8 1.5 4.1 4.9
#90 P.A. 48 Hodgkin lymphoma, high dose 146 37 161 39 159 58 8.8 6.67 111 40 4.7 1.7 3.9 5.1
chemotherapy toxicity
#91 N.M. 58 Ovarian cancer, lymph nodes and liver 132 29 155 11 161 62 7.9 6.2 128 11 5.9 1.2 2.7 4.4
metastasis
#92 A.F. 63 Colon Cancer , high dosage 105 18 149 18 160 69 8.3 6.5 115 18 5.6 1.4 2.7 4.7
chemotherapy
#93 C.G. 54 Left colon cancer, liver metastasis 109 12 137 8 153 48 7.8 6.9 110 32 4.0 1.8 3.4 4.0
#94 G.E. 62 Hodgkin lymphoma, high dose 167 44 120 17 178 50 8.1 6.7 148 28 3.8 1.4 3.6 4.1
chemotherapy toxicity
#95 C.G. 68 Pancreatic cancer speading into 182 37 116 20 185 56 11.2 9.2 161 31 4.2 1.7 3.9 4.3
epiploon and liver intrarterial
chemotherapy
#96 L.A.M. 65 Duodenal cancer, Krukenberg's 178 23 131 12 192 42 10.2 8.8 94 48 4.8 1.8 3.4 4.6
tumour, 18 Oxaliplatin therapy, high
dosage
#97 L.P. 70 Left colon cancer, liver metastasis 155 13 199 34 167 51 11.7 7.5 104 28 5.4 1.4 2.4 4.9
#98 G.A. 77 Ovarian cancer, taxol + carboplat. 103 9 175 10 159 67 9.9 6.3 108 35 5.9 1.6 2.9 3.8
toxicity
#99 L.L. 58 Colon cancer with diffuse metastasis 118 17 147 21 169 43 10.2 5.8 117 49 5.2 1.9 2.3 3.7
#100 L.G. 63 Liver metastasis from colon cancer 176 41 142 9 172 40 9.7 6.6 159 17 5.1 1.2 4 5
Table 1:- Liver parameters in parenteral bile salts therapy

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Volume 5, Issue 3, March – 2020 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165

Fig 1:- Graphic representation of clinical parameters in patients with parenteral treatment

Fig 2:- Graphic representation of bilirubin and albumin value in parenteral bile salts group (n=100 patients)

Fig 3:- Graphic representation of symptoms in parenteral bile salts therapy group before and after treatment

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Volume 5, Issue 3, March – 2020 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
IV. DISCUSSION AND CONCLUSIONS

The patients affected by cancer with gut function


impairment, and liver dysfunction due either to
chemotherapy toxicity, liver metastasis, or paraneoplastic
effects have a very poor life quality that can effectively be
improved by administration of biliary salts via parenteral
route, because the oral delivery wouldn’t reach adequate
absorption rate and would potentially generate adverse
effects.

In our case series we observed after the third


intravenous infusion, a quick improvement of the
symptoms, especially asthenia, post- prandial somnolence,
insomnia, reflux and meteorism heaviness in the right
hypochondrium, biliary colics, itching, skin eruptions,
dermographism etc (FIG.2).

The intermittent treatment with intravenous bile salts


is thus advisable and can also maintain the enterohepatic
circle notwithstanding the intestinal problems and the bad
nutritional conditions, and in prolonged starvation and total
parenteral nutrition it prevents also the stones formation.

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