CLINICAL FEATURES OF GASTROINTESTINAL ULCERATIVE BLEEDING IN ELDERLY PATIENTS COMPLICATED BY CARDIO-VASCULAR PATHOLOGY

Abstract

The aim: To determine clinical and endoscopical features of gastroduodenal hemorrhages in elderly patients with concomitant cardio-vascular pathology in a way by studying, main indicators of the immune system for drawing up further tactics. Material and methods: The study included 609 patients with ulcerative gastroduodenal bleeding, complicated by cardio-vascular system pathology in 2017-2019 years. The observed patients were distributed into the groups: I - patients, who received treatment according to the standard system of cardiovascular pathology treatment (n=541), II - "double" therapy (n=68). Control group consists of 20 relatively healthy patients were similar to the research group. Results: Blood lost of a big amount and massive blood lost were noticed in 113 (18.56%±1.58) and 121 (19.87%±1.62) patients respectively. Active bleeding (F I) was revealed in 38 patients (6.24%±0.98), a high risk of hemorrhage relapse was determined in 486 patients (79.80%±1.63). Signs of recent hemorrhage were absent in 85 patients (13.96%±1.40). A high level of pro-inflammatory cytokines IL-6, TNF-α and a low activity of the anti-inflammatory mediator IL-10 define the process activity, their long-term circulation in patients with ulcerative hemorrhages of the gastro-intestinal tract are associated with unfavorable prognosis. In 5 cases conditionally-radical surgical interventions were performed. Palliative surgery - 3 patients (р>0.05). Conclusions: The patients of second group ("double therapy") with big and massive blood loss was 2.7 times higher than similar indices in patients of the first group (standard therapy). The patients who received "double therapy" had 3.3 times more active hemorrhage percentage than the patients who received standard therapy (р<0.05).