Gastroduodenal Ulcer Bleeding Research Articles

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


 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.

MINIMALLY INVASIVE TECHNOLOGIES OF TREATMENT OF NON-VARICOSE ESOPHAGOINTESTINAL GASTRIC BLEEDING

OBJECTIVE. The enhancement of direct results of treatment in patients with a bleeding gastro-duodenal ulcer and the Mallory–Weise syndrome using endoscopic and endovascular methods of hemostasis. MATERIAL AND METHODS. In this paper, the treatment results of the 253 patients with Mallory–Weise syndrome and the results of the 1063 patients with a bleeding gastro-duodenal ulcer are analyzed. RESULTS. An endoscopic hemostasis was conducted for all patients with a Mallory–Weise syndrome. For patients with bleeding ulcer: the injection therapy and unipolar coagulation were done for 238 patients (the bleeding recurrence was detected in 21 cases (8.8 %)); the injection therapy and argon plasma therapy were conducted for 341 patients (the bleeding recurrence was detected in 19 cases (5.6 %)); the injection therapy and clipping of vessels were conducted for 236 patients (the bleeding recurrence was detected in 11 cases (4.7 %)); the ulcer ligation was done for 98 patients without bleeding recurrences. 151 persons were treated only with the conservative treatment, while the recurrence was detected with 49 persons (32.5 %). The primary surgical treatment was done for 46 (4.3 %) patients, who had the traces of a heavy blood loss but it was not possible to visualize its source. Two patients died. 106 patients underwent an X-ray endovascular surgical procedure aimed at reaching the hemostasis. 100 patients of them had a bleeding recurrence and 6 of them had a comorbidity index over 30 points and a high risk of bleeding recurrence. One person with an acute cardiac insufficiency died. CONCLUSION. The bleeding recurrence and a high comorbidity index provide an evidence for undertaking X-ray endovascular method of hemostasis.

New technologies of endoscopic hemostasis in a treatment protocol of patients with gastroduodenal ulcer bleeding

Relevance of research. Acute gastroduodenal bleeding is remaining a difficult and largely unsolved problem up to day. The fundamental importance in treating this category of patients is an endoscopic hemostasis. The decisive point in this problem is the most stable hemostasis and preventing a recurrence of a hemorrhage. In this regard, the search of new solutions and the development of known methods of treatment of the gastroduodenal ulcer bleeding is an important issue.
 
 Aim of research. To evaluate the effectiveness of the treatment protocol of patients with the gastroduodenal ulcer bleeding by applying combined endoscopic insufflations of hemostatic agents and a diovin as an integral part of a complex therapy.
 
 Materials and methods. The research is based on results of treatment of the patients with the gastroduodenal ulcer bleeding being in a medical setting at the departments of surgery at Voronezh city clinical emergency hospital №1. During the treatment of the main group (59 patients) there was used an integrated approach with the usage of powdered hemostatic agents of gelplastan and lyophilisate NovoSeven in combination with diovin in the endoscopic treatment of gastroduodenal ulcer bleeding. There were used the traditional well-known methods of the endoscopic hemostasis without the usage of hemostatic agents and absorbent grains in treatment of the control group (56 patients).
 
 Results and discussion. The evaluation of results of patients’ treatment with gastroduodenal ulcer bleeding was performed according to the figures of the final hemostasis, the frequency of recurrent bleeding, the prevention of emergency operations, the rates of mortality, the duration of hospitalization. The developed protocol of the patients’ treatment with gastroduodenal ulcer bleeding with the usage of combined the endoscopic insufflation of two hemostatics and diovin makes it possible to achieve the maximum persistent hemostasis at 94.9% of patients, to reduce the risk of recurrent hemorrhages by 2.5 times, to prevent emergency operations and, as a result, to reduce the lethality.
 
 Conclusion. The usage of new technologies of endoscopic hemostasis by the hemostatic pneumoinsufflation gelplastan and lyophilisate NovoSeven in combination with diovin in the treatment of patients with gastroduodenal ulcer bleeding allows to reduce the risk of recurrent hemorrhage from 12,5% to 5,01% (by 2,5 times), to prevent emergency operations, to reduce the lethality from 3,65% to 1,7% (by 2,1 times) and to reduce the period of staying in the hospital from 10,2 to 7,4 bed days (p<0.05).

Validity of the Pre-endoscopic Scoring Systems for the Prediction of the Failure of Endoscopic Hemostasis in Bleeding Gastroduodenal Peptic Ulcers.

Objective Although several pre-endoscopic scoring systems have been used to predict the mortality or the need for intervention for upper gastrointestinal bleeding, their usefulness to predict the failure of endoscopic hemostasis in bleeding gastroduodenal peptic ulcers has not yet been fully investigated. In this study, we evaluated the usefulness of the Glasgow-Blatchford score (GBS), the clinical Rockall score (CRS), and the AIMS65 score in predicting the failure of endoscopic hemostasis in patients with bleeding gastroduodenal peptic ulcers. Methods We retrospectively evaluated 226 consecutive emergency endoscopic cases with bleeding gastroduodenal peptic ulcers between April 2010 and September 2016. The study outcome was the failure of first endoscopic hemostasis. The GBS, CRS, and AIMS65 scores were assessed for their ability to predict the failure of endoscopic hemostasis using a receiver-operating characteristic curve. Results Eight cases (3.5%) failed to achieve first endoscopic hemostasis. Surgery was required in six cases, and interventional radiology was required in two cases. The GBS was superior to both the CRS and the AIMS65 score in predicting the failure of endoscopic hemostasis [area under the curve, 0.77 (95% confidence interval, 0.64-0.90), 0.65 (0.56-0.74) and 0.75 (0.56-0.95), respectively]. No failure of endoscopic hemostasis was noted in cases in which the patient scored less than GBS 10 and CRS 2. Conclusion The GBS was the most useful scoring system for the prediction of failure of endoscopic hemostasis in patients with bleeding gastroduodenal peptic ulcers. The GBS was also useful in identifying the patients who did not require surgery or interventional radiology.

ТАКТИКА ЛЕЧЕНИЯ ПАЦИЕНТОВ С ЯЗВЕННЫМИ ГАСТРОДУОДЕНАЛЬНЫМИ КРОВОТЕЧЕНИЯМИ

Background. In spite of the achievements of modern gastroenterology the number of patients with ulcerative gastroduodenal bleeding do not tend to decrease. Lethality is still rather high – from 10 to 15%, which reaches 20-45% during the recurrence of bleeding. Endoscopic hemostasis was effective in 96-98% of the patients only. Indications for surgical treatment when endoscopic hemostasis has been performed are still the subject of discussion. Purpose. To analyze data on the results of emergency care and treatment of the patients with gastroduodenal ulcer bleeding in the city specialized bleeding center to optimize therapeutic and diagnostic tactics. Material and methods. The analysis of data on the results of treatment of 981 patients with ulcerative gastroduodenal bleeding. Results. In the clinic, an algorithm for therapeutic and diagnostic measures for effective treatment of the patients has been developed, based on the possibility of carrying out 24-hour endoscopy study, which makes it possible to identify the source of bleeding in the shortest possible time, to determine its character, to assess the stability of hemostasis, and simultaneously perform endoscopic hemostasis (temporary or final). Further therapeutic tactics is based on the complex prediction of gastroduodenal ulcer bleeding recurrence, the automated assessment of the severity of the patient's condition with the definition of the degree of operational risk and the rational replenishment of the circulating blood volume based on a computerized assessment of the transfusion requirement. Conclusions. The application of modern endoscopic methods of bleeding control enabled to reach the final hemostasis in 99.3% of patients with gastroduodenal ulcer bleeding which significantly reduced the number of emergency operations.

The role of in-hospital protocols in diagnosis and treatment of ulcerative gastroduodenal bleeding

To improve immediate results in patients with acute ulcerative gastroduodenal bleeding. The study enrolled 91 patients with ulcerative gastroduodenal bleeding. Diagnostic and curative procedures should be related to hospital's equipment, specialists' qualification and comprehensive development and application of accepted tactical approaches. 20-year development of this protocol which includes original low-temperature irrigator of stomach and duodenal mucous membranes, objective choice of endoscopic hemostasis technique depending on bleeding source in gastroduodenal wall, early administration of proton pump inhibitors significantly increases efficacy and reliability of endoscopic hemostasis. It was followed by improved early outcomes: recurrent bleeding incidence was 4.2%, surgical activity decreased by 68% up to 13.2%, overall and postoperative mortality was 2.2% and 8.3% respectively.

Features of disorders of the system of cytokines and lipid peroxidation in acute ulcerative gastroduodenal hemorrhages

Aim. Investigation of the local and systemic levels of some pro- and anti-inflammatory cytokines as well as the system of lipid peroxidation - antioxidant defense of the organism in acute ulcerative gastroduodenal hemorrhages, taking into account the severity of the blood loss. 
 Methods. We performed the investigation of cytokines in the blood (tumor necrosis factor α, interferon γ, interleukin-1, -2, -4, -6, -8, -10) and parameters of lipoperoxidation (in plasma - diene conjugates, malonic dialdehyde, catalase; in erythrocytes - reduced glutathione, glutathione peroxidase, total antioxidant activity), interleukin-6 in gastric content and urine, diene conjugates and malonic dialdehyde in biopsy samples from the ulcer edges from patients with acute ulcerative gastroduodenal bleeding. The blood serum of 156 patients with mild (54), moderate (51) and severe (51) bleeding was studied. Interleukin-6 in gastric contents was determined in 37 patients, diene conjugates and malonic dialdehyde in biopsy samples taken from periulcerous zone - in 20 patients. 
 Results. Patients had a statistically significant increase of serum levels of tumor necrosis factor α, interferon γ, interleukins-1, -2, -4, -6, -8, and decrease of interleukin-10 concentration in comparison with the control group. The level of interleukin-6 in gastric juice was 37.5% lower, and in urine - 8.2 times higher than the control value. In plasma and biopsy samples, the content of diene conjugates and malonic dialdehyde was statistically significantly higher, in erythrocytes the level of reduced glutathione was lower than the control value. The depth of imbalance in the system of cytokines and lipid peroxidation - antioxidant defense increased with increasing of blood loss severity. 
 Conclusion. The relationship between cytokine production and lipid peroxidation indices is established, which confirms the role of local and systemic disorders of cytokine and antioxidant status in the occurrence of ulcer bleeding.

The Use of Asepticob-A and Platelet-rich Plasma in Complex Endoscopic Teatment of Patients with Ulcer Gastroduodenal Bleeding

Relevance. Gastroduodenal ulcer bleeding is one of the most complex problems of emergency abdominal surgery. An endoscopic hemostasis is a crucial importance during the treatment of patients with gastroduodenal bleeding. The using of biologically active draining sorbents in combination with local haemostatic drugs is a promising direction in the endoscopic hemostasis.Objective. The aim of the investigation is to improve the results of treatment of patients with acute ulcerative gastroduodenal hemorrhages by application of biologically active draining of sorbent Asepticob-A in combination with platelet-rich plasma for endoscopic hemostasis as an important component of complex therapy.Materials and methods. The study is based on the results of treatment of 112 patients with peptic ulcer bleeding. They were treated in the specialized city centre for the treatment of patients with gastrointestinal bleeding of Voronezh state hospital of emergency medical care №1. During the treatment of patients of the main group (n=57 persons) was used individual complex approach with the using of biologically active draining of sorbent of new generation – Asepticob-A and platelet-rich plasma in endoscopic treatment of bleeding complications of gastroduodenal ulcers. In the comparison group (n=55 persons) was used the well-known traditional methods of endoscopic hemostasis without the use of granular sorbents and platelet-rich plasma.Results and discussion. The effectiveness of treatment of patients with ulcerative gastroduodenal bleeding was assessed according to the criteria of reliability of hemostasis, assessment of dynamics of reparative processes in ulcerous defects, the frequency of recurrence of bleeding on the background of treatment using endoscopic techniques, prevention, emergency operations and mortality rate. The methods of treatment of gastroduodenal bleeding with the combined use of biologically active draining sorbents and platelet-rich plasma for the reliability of endoscopic haemostasis, that was developed and introduced into clinical practice, reduces the number of emergency operations in 2.6 times, mainly due to the reduction of recurrent bleeding and, as a consequence, leads to lower postoperative mortality.Conclusions. The use of biologically active draining of sorbent Asepticob-A and platelet-rich plasma in complex endoscopic treatment of patients with ulcerative gastroduodenal bleeding allows to reduce the frequency of recurrence of bleeding from 10.9% to 3.5% (3.1 times), to reduce the number of emergency surgical interventions at the height of bleeding from 9.1% to 3.5% (2.6 times), to reduce postoperative mortality from 5.45% to 1.75% (3.1 times) and reduce the duration of inpatient treatment from 9.0 to 6.0 days (p<0.05).

Management of upper gastrointestinal bleeding in emergency departments, from bleeding symptoms to diagnosis: a prospective, multicenter, observational study

BackgroundUpper gastrointestinal bleeding (UGB) is common in emergency departments (EDs) and can be caused by many eso-gastro-duodenal lesions. Most available epidemiological data and data on the management of UGB comes from specialized departments (intensive care units or gastroenterology departments), but little is known from the ED perspective.We aimed to determine the distribution of symptoms revealing UGB in EDs and the hemorrhagic lesions identified by endoscopy. We also describe the characteristics of patients consulting for UGB, UGB management in the ED and patients outcomes.MethodThis was a prospective, observational, multicenter study covering 4 consecutive days in November 2013. Participating EDs were part of the Initiatives de Recherche aux Urgences network coordinated by the French Society of Emergency Medicine. All patients with suspected UGB in these EDs were included.ResultsIn total, 110 EDs participated, including 194 patients with suspected UGB (median age 66 years [Q1-Q3: 51-81]). Overall, 104 patients (54%) had hematemesis and 75 (39%) melena. Endoscopy revealed lesions in 121 patients, mainly gastroduodenal ulcer or ulcerations (41%) or bleeding lesions due to portal hypertension (20%). The final diagnosis of UGB was reversed by endoscopy in only 3% of cases. Overall, 67 patients (35%) had at least one severity sign. Twenty-one patients died (11%); 40 (21%) were hospitalized in intensive care units and 126 (65%) in medicine departments; 28 (14%) were outpatients. Mortality was higher among patients with clinical and biological severity signs.ConclusionMost of the UGB cases in EDs are revealed by hematemesis. The emergency physician diagnosis of UGB is rarely challenged by the endoscopic findings.

Continuing use of antithrombotic medications for patients with bleeding gastroduodenal ulcer requiring endoscopic hemostasis: a case–control study

Objective: The aim of this study was to compare clinical characteristics and outcomes of bleeding gastroduodenal ulcer between patients taking antithrombotic medications and those not taking antithrombotic medications.Methods: We performed a case–control study of 346 patients with endoscopically verified bleeding gastroduodenal ulcer, which included 173 cases taking antithrombotic medications throughout peri-bleeding period and 173 age- and sex-matched controls not taking antithrombotic medications.Results: The cases showed less frequent Helicobacter pylori (H. pylori) infections (45.1% versus 60.7%, p = .005), more frequent duodenal location (31.8% versus 19.1%, p = .009), and more frequent rebleeding (13.9% versus 5.8%, p = .02) than the controls. Multivariate analysis revealed that duodenal location (odds ratio [OR] 3.01, 95% confidence interval [CI] 1.37–6.65) and use of antithrombotic medications (OR 2.47, 95% CI 1.13–5.77) were independent factors for rebleeding. However, there were no differences in clinical outcomes, including final successful endoscopic hemostasis, need for surgical intervention, and mortality between cases and controls. Thromboembolic events did not occur in any cases and controls during the periendoscopic period.Conclusions: Low prevalence of H. pylori infection, frequent duodenal location, and high rebleeding rate are characteristics of patients with bleeding gastroduodenal ulcer under antithrombotic medications. Continuation of antithrombotic medications can be accepted for bleeding gastroduodenal ulcer.

The clinical and cost implications of failed endoscopic hemostasis in gastroduodenal ulcer bleeding.

The aim of this article is to evaluate the clinical and cost implications of failed endoscopic hemostasis in patients with gastroduodenal ulcer bleeding. A retrospective claims analysis of the Medicare Provider Analysis and Review (MedPAR) file was conducted to identify all hospitalizations for gastroduodenal ulcer bleeding in the year 2012. The main outcome measures were to compare all-cause mortality, total length of hospital stay (LOS), hospital costs and payment between patients managed with one upper gastrointestinal (UGI) endoscopy versus more than one UGI endoscopy or requiring interventional radiology-guided hemostasis (IRH) or surgery after failed endoscopic attempt. The MedPAR claims data evaluated 13,501 hospitalizations, of which 12,242 (90.6%) reported one UGI endoscopy, 817 (6.05%) reported >1 UGI endoscopy, 303 (2.24%) reported IRH after failed endoscopy and 139 (1.03%) reported surgeries after failed endoscopy. All cause-mortality was significantly lower for patients who underwent only one UGI endoscopy (3%) compared to patients requiring >1 endoscopy (6%), IRH (9%) or surgery (14%), p < 0.0001. The median LOS was significantly lower for patients who underwent only one UGI endoscopy (four days) compared to patients requiring >1 endoscopy (eight days), IRH (nine days) or surgery (15 days), p < 0.0001. The median hospital costs were significantly lower for patients who underwent one UGI endoscopy ($10,518) compared to patients requiring >1 endoscopy ($20,055), IRH ($34,730) or surgery ($47,589), p < 0.0001. Failure to achieve hemostasis at the index endoscopy has significant clinical and cost implications. When feasible, a repeat endoscopy must be attempted followed by IRH. Surgery should preferably be reserved as a last resort for patients who fail other treatment measures.

Organization and results of surgical care for ulcerative gastroduodenal bleeding in the hospitals of Central Federal District

To present treatment of 52 149 patients with ulcerative gastroduodenal bleeding (UGDB) who were treated in different regions of Central Federal District (CFD) for the period 2011-2014. It is noted that UGDB incidence per 100 thousands is increased proportionally from 32.9 to 77.8 according to population less than 20 and over 100 thousands, respectively. In hospitals of small and medium settlements the number of UGDB patients without surgery reaches 81.6 and 81.1%, the number of operated patients - 18.4 and 18.9% respectively. In hospitals of large settlements this ratio is 90.1 and 90.6%, the number of operated patients - 9.9 and 9.4%, respectively. In areas of Central Federal District the mortality rate in patients without surgery is 3.9-8.2%, in operated patients - 17.4-36.9%. Structured analysis of the organization of surgical care in Central Federal District revealed the relationship between outcomes and efficient use of endoscopic diagnostics and haemostasis. In municipal hospitals of Central District endoscopic technologies are insufficiently used for final elimination of ulcerative bleeding.

Clinical evaluation of endoscopic hemostasis in patients with ulcerative gastroduodenal bleeding

To compare the effectiveness of various methods of endoscopic hemostasis in patients with ulcerative gastroduodenal bleeding. Several surgical techniques in treatment of 117 patients with ulcerative gastroduodenal bleeding were anayzed. Isolated and combined methods of endoscopic hemostasis were used in control and study groups. Combined endoscopic hemostasis is bettercompared with isolated techniques. It reduces the incidence of recurrence, surgical activity and mortality. The effectiveness of combined endoscopic hemostasis was 88.2% for primary hemostasis in acute ulcerative gastroduodenal bleeding. Herewith, surgical activity and mortality were decreased.

The causes of recurrent ulcerative gastroduodenal bleeding

To explore microcirculatory changes within the first 48 hours after admission, to compare them with clinical manifestations of bleeding and to define the dependence of recurrent bleeding from the therapy. The study included 108 patients with ulcerative gastroduodenal bleeding who were treated at the Clinical Hospital #71 for the period 2012-2014. There were 80 (74.1%) men and 28 (25.9%) women. Age ranged 20-87 years (mean 54.4±16.8 years). Patients younger than 45 years were predominant (33.4%). J. Forrest classification (1974) was used in endoscopic characterization of bleeding. Roccal Prognostic Scale for gastroduodenal bleeding was applied in all patients at admission to assess the risk of possible recurrence. Patients were divided into 2 groups. Group 1 included 53 (49.1%) patients without recurrent bleeding; group 2-55 (50.1%) patients who had recurrent bleeding within the first two days of treatment. Investigation of microcirculation showed the role of vegetative component including blood circulation centralization, blood flow slowing, blood cells redistribution providing sufficient blood oxygenation. By the end of the first day we observed pronounced hemodilution, decreased blood oxygenation, blood flow restructuring with its acceleration above 1 ml/s, violation of tissue oxygenation, signs of hypovolemia. These changes were significantly different from group 2 and associated with circulatory decentralization with possible pulmonary microcirculation disturbances and interstitial edema. This processes contribute to disruption of tissue oxygenation. We assume that recurrent bleeding in group 2 was caused by fluid therapy in larger volumes than it was necessary in this clinical situation. Infusion therapy should be significantly reduced for the debut of gastroduodenal ulcerative bleeding. Sedative therapy is advisable to reduce the influence of central nervous system.

Characteristics and outcomes of gastroduodenal ulcer bleeding: a single-centre experience in Lithuania.

IntroductionDespite the optimal use of combined endoscopic haemostasis and pharmacologic control of acid secretion in the stomach, mortality in patients with peptic ulcer bleeding (PUB) has remained constant. Recent data has shown that the majority of patients with PUB die of non-bleeding-related causes.AimTo provide an overview of our experience of PUB management, with emphasis on the effect of age, gender, comorbidities, and drug use on the characteristics and outcomes of gastroduodenal ulcer bleeding.Material and methodsWe retrospectively reviewed the medical records of all patients admitted with the primary diagnosis of acute, chronic or unspecified gastric and/or duodenal ulcer with haemorrhage during 2008–2012.ResultsTwo hundred and nineteen patients were identified. 46.6% of patients were ≥ 65 years old (elderly) and 53.4% were < 65 years old (young). The young patients were more likely to have duodenal ulcers and liver failure at admission. Previous use of medications was more regularly observed in gastric ulcer patients than in duodenal ulcer patients. Rebleeding occurred in 43 (19.6%) patients and death in 5 (2.3%) patients. Increased risk of mortality in our patients was associated with age ≥ 65 years (RR = 2.21; 95% CI: 1.90–2.56; p = 0.021).ConclusionsManagement of peptic ulcer bleeding should aim at reducing the risk of multiorgan failure and cardiopulmonary death instead of focusing merely on successful haemostasis.

OPTIMIZATION OF SURGICAL TACTICS ULCEROUS GASTRODUODENAL BLEEDING

The aim of our research is to determine ways of improving the results of surgical treatment of gastroduodenal ulcer bleeding. A promising trend is to be recognized a surgical strategy based on the prediction of recurrence of bleeding. The results of therapy of 2365 patients with bleeding-forming ulcers of gastroduodenal zone, who have been taking steady-nary treatment in MBHI KCC HEMC Krasnodar from 2009 till 2016 years. The have been analysed recurrence of bleeding effect in hospital was registered in 419 cases (17,7 %). The main criteria for the choice of tactics of treatment of gastroduodenal ulcer bleeding are: the degree of stability of the hemostasis of the ulcer, the severity of the bleeding and degree of the "operation risk". Additional criteria include: location, size of ulcers and the criteria for the violation of hemostasis. Differential approach based on the prediction of recurrence of bleeding, will help to improve treatment and reduce postoperative mortality in gastroduodenal bleeding.

Determination of the Risk of Recurrent Gastroduodenal Ulcer Bleeding

Despite the advances in endoscopic haemostasis, the incidence of recurrent ulcer bleeding remains to be high. It necessitates further search for its prognosis and methods of treatment.The objective of the research was to analyse risk factors for recurrent gastroduodenal ulcer bleeding.Materials and methods. The study included 203 patients with gastroduodenal ulcer bleeding. There were 135 (66.5%) males and 68 (33.3%) females. All the patients were examined and received conservative treatment according to treatment protocols.Results. Duodenal ulcer was diagnosed in 127 (62.3%) patients, gastric ulcer was found in 68 (33.3%) patients, gastroduodenal ulcer was seen in 9 (4.4%) patients. The recurrence of bleeding was observed in 24 (11.8%) cases. Most cases of recurrent bleeding (n=11 (45.8%) occurred within 2-3 days after the admission. 9 (37.5%) patients developed the recurrence of bleeding later. The lowest number of recurrent bleeding occurred within the first day - 4 (16.7%) cases. The incidence of recurrent bleeding was higher in men rather than in women - 17 (70.8%). Recurrent bleeding was observed in 9 (64.29%) patients with blood type O; 4 (28.57%) patients with blood type A; 1 (7.14%) patient with blood type B; 1 (7.14%) patient with blood type AB. The majority of recurrences (n=15 (62.5%) occurred in patients without ulcer in anamnesis. There was found no clear connection between ulcer location and the rate of recurrent bleeding.Conclusions.The scales of predicting recurrent bleeding that are known today do not consider a number of important clinical and pathogenetic factors as a basis of recurrence.The improvement of the results of treating bleeding ulcers is possible only on the basis of the complex of factors determining the effectiveness of regeneration.

Guidelines for endoscopic management of non-variceal upper gastrointestinal bleeding.

Japan Gastroenterological Endoscopy Society (JGES) has compiled a set of guidelines for endoscopic management of non-variceal upper gastrointestinal bleeding using evidence-based methods. The major cause of non-variceal upper gastrointestinal bleeding is peptic gastroduodenal ulcer bleeding. As a result, these guidelines mainly focus on peptic gastroduodenal ulcer bleeding, although bleeding from other causes is also overviewed. From the epidemiological aspect, in recent years in Japan, bleeding from drug-related ulcers has become predominant in comparison with bleeding from Helicobacter pylori (HP)-related ulcers, owing to an increase in the aging population and coverage of HP eradication therapy by national health insurance. As for treatment, endoscopic hemostasis, in which there are a variety of methods, is considered to be the first-line treatment for bleeding from almost all causes. It is very important to precisely evaluate the severity of the patient's condition and stabilize the patient's vital signs with intensive care for successful endoscopic hemostasis. Additionally, use of antisecretory agents is recommended to prevent rebleeding after endoscopic hemostasis, especially for gastroduodenal ulcer bleeding. Eighteen statements with evidence and recommendation levels have been made by the JGES committee of these guidelines according to evidence obtained from clinical research studies. However, some of the statements that are supported by a low level of evidence must be confirmed by further clinical research.

The effect of cytokine therapy on the results of surgical treatment of patients with acute ulcerative gastroduodenal bleeding

To improve the results of surgical treatment of patients with acute ulcerative gastroduodenal bleeding using immune correction with β-leukin. Urgent and elective operations were performed in 120 patients with gastroduodenal ulcers. Patients of the main group (n=63) received systemic cytokine therapy with β-leukin in addition to conventional treatment. Pre- and postoperative immune correction was absent in the comparison group. There was preoperative imbalance of antiphlogistic and proinflammatory cytokines in comparison group. Severity of this process depended on blood loss. Therapy with interleukin decreased severity of cytokine imbalance.

Relationship between leukocytes recruitment and risk of rebleeding in patients with peptic ulcers

AimThe aim of this study was to assess the impact of leukocytes reaction on rebleeding development among patients with peptic ulcers. MethodsThis was a single-center cohort study enrolling 232 patients with a diagnosis of gastroduodenal ulcer bleeding. The end point was the in-hospital rebleeding rate during the three days after admission. The impact of clinical, demographic, endoscopic and laboratory data at the time of admission, as well as macrophages (CD68) and neutrophils count in ulcer margin, on bleeding outcome was assessed. In addition, impact of the leukocytes on the platelets aggregation induced with ADP (5μM) and collagen (1μM) was measured in vitro. ResultsAcute ulcer bleeding was accompanied with an acute inflammatory response to damage and hemorrhage. Despite the increase of neutrophil count (P=0.031) in peripheral blood of bleeders, there were not significant influence of this parameter on the outcome. It was shown that the most significant predicting factors were an increased neutrophils (OR 1.4; 95% CI 1.1–1.8) and macrophages count in the ulcer margin (OR 3.5; 95% CI 1.9–4.87); an endoscopically diagnosed active bleeding (OR 3.0; 95% CI 1.4–6.3); an enhanced level of plasma fibrinogen (OR 1.04; 95% CI 1.0–1.08). Co-incubation of platelets with leukocytes significantly decreased the collagen induced aggregation (P=0.008) that could indicate either alteration of mechanisms of platelets adhesion, or inhibition of stabilization phase of thrombogenesis. ConclusionThe severity of the local acute inflammatory reaction promotes progressive tissue damage of ulcer margin, and increases the risk of rebleeding.