Evaluation of the dynamics of the main indicators of treatment care and the long-term results of conservative treatment of ulcerative gastroduodenal bleeding

Abstract


 Relevance. Improvement of medical and diagnostic care for ulcerous gastroduodenal bleeding is a complex problem of modern medicine, the solution of which is connected both with the search for and introduction of modern medical technologies into clinical practice, and with the necessity to conduct in-depth analysis of the effectiveness of medical care in this pathology at various stages of its delivery.
 Purpose .To study the dynamics of the main indicators of the provision of medical and diagnostic care to patients with ulcerative gastroduodenal bleeding in a large multidisciplinary hospital and to evaluate the long-term results of conservative treatment of this group of patients.
 Materials and methods. An assessment of the dynamics of the main indicators of the provision of medical and diagnostic care for ulcerative gastrointestinal bleeding in the Voronezh Regional Clinical Hospital for the period from 1989 to 2010, during which 1831 patients were hospitalized. Long-term results of 106 patients were analyzed. Among the patients, males predominated (70.7%), the average age was 50.2 ± 4.7 years (median - 18 - 79 years). In 62 patients (58.5%) bleeding ulcer was located in the duodenum.
 Results. During the analyzed period there was a general tendency to reduce the number of hospitalizations by 57.8%. Surgical activity in this pathology in 1989-1993 was 56.0%; in the period from 2009 to 2013, this indicator decreased to 33.8% against the background of an increase in the postoperative mortality to 8.7%. In the evaluation of long-term results, favorable outcomes of treatment were noted - in 74.5% of patients. In 17.9% of patients with peptic ulcer with predominant localization of ulcers in the DPC, the development of various complications and recurrences of bleeding was noted, which gives grounds for recommending in the current situation the implementation of planned surgical interventions.
 Conclusions. Conservative treatment of ulcerative gastroduodenal bleedings with the use of endoscopic technologies creates conditions for optimization of immediate and long-term outcomes of treatment. The polyethiologic nature of the disease and the significant specific gravity of severe combined pathology makes it urgent to introduce a multidisciplinary brigade principle for the treatment of ulcerative gastroduodenal bleeding.
 Key words: ulcerative gastroduodenal bleeding.