Comprehensive Medical Therapy in Acute Gastroduodenal Ulcer Bleeding
Objective: to study the effectiveness of various applications of proton pump inhibitors (PPIs) and H2-blockers of histamine receptors (H2BHR) to improve the quality of care of patients with acute gastroduodenal ulcer bleeding.
Material and Methods. During the period from 2008 to 2012 in the clinic of surgery and endoscopy Donetsk national medical university 1494 patients with gastric ulcer (GU) and duodenal ulcer (DU), aged 18 to 87 years, were hospitalized. GU was diagnosed in 326 (21.8 %) patients, GU — in 1089 (72.9 %) patients. 79 (5.3 %) patients had a combined localization of bleeding point. Men was 958 (64.1 %), women — 536 (35.9 %). To facilitate the analysis of groups of patients, a database in the form of a spreadsheet program Microsoft Office Excel was created. It reflected the clinical, endoscopic, laboratory data, endoscopic manipulation during endoscopic monitoring, drug therapy, outcomes. In total 177 parameters.
Results and Discussion. The clinic adopted individually rational strategy, including personalized and dynamic approach to the choice of treatment strategy, balanced pharmacological treatment program, the rational use of therapeutic endoscopic techniques (endoscopic monitoring using whole diagnostic and therapeutic endoscopic methods). To achieve the objectives of the study there had been selected patients whose tactical principles implemented in full. 77 patients (5.3 %), in whom endoscopic treatment monitoring and adequate drug therapy were not carried out, were excluded from the analysis. They are sick elderly without critically evaluating their condition, refusing treatment, etc. Thus, the test group was 1,417 (94.7 %) patients. Besides above mentioned, special sampling of patients, depending on the endoscopic pattern and used endoscopic techniques, haven’t been conducted.
3 groups of patients were created. The first two groups received PPIs on the conventional scheme. The first group included patients with moderate and low risk of rebleeding. The second group included patients with high risk of rebleeding (HRR). In the third group (group with HRR) PPIs and H2BHR had been used simultaneously.
It should be noted that in all groups any deterioration of endoscopic pattern — the appearance in the lumen or on walls of content of the «coffee ground» or hemorrhagic plaque, clots, when vessels were determined before in the bottom of the defect, served as RR. Some patients (up 3.5 %) had clinically significant RR, when deterioration of endoscopic pattern was associated with clinical manifestations.
In the first group the nubmer of RR ranged from 4.1 to 5.8 % and averaged 4.9 %. In the second group some fluctuations in over the years were also observed, but on average it was 14.1 %. The third group of patients is noteworthy. First, the observed gradual increase in the number of patients in the group from 12 in 2008 to 68 in 2012. Secondly — the reduction in relapse rate in this group. Because of low number of patients in this group, we did not take into account 2008 and 2009, when RR number was 25 and 21.1 %, respectively. The relative alignment of the number of patients in the second and third groups had an impact on results. Thus, in subsequent years the RR number in the third group decreased by 2–2.5 times and averaged 13 %.
Conclusions. Acid-suppressive therapy is now an indispensable component of a balanced medical treatment of hemorrhagic complications of peptic ulcer disease. Features of its application, selection of qualitative composition, based on the clinical features of the disease, requires further study. These data, as well as further data analysis, show high efficiency of such a combination of proton pump inhibitors and H2-blockers of histamine receptors, which is especially important in patients with high operational and anesthetic risk. A decrease in the period of treatment in the intensive care unit from 32 ± 6 hours to 28 ± 3 hours was noted, qualitative indicators of treatment have changed.
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