Comprehensive Medical Therapy in Acute Gastroduodenal Ulcer Bleeding

P.G. Kondratenko, Ye.Ye. Radenko, S.O. Zharikov

Abstract


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.


Keywords


gastroduodenal ulcer bleeding; recurrent bleeding

References


Затевахин И.И. Обоснование лечебной тактики при кровотечениях из хронических язв желудка и двенадцатиперстной кишки / И.И. Затевахин, А.А. Щеголев // Тез. докл.VIII Всеросс. съезда хирургов. — Краснодар, 1995. — С. 97-98.

Кайбышева В.О. Гастроэзофагеальная рефлюксная болезнь, резистентная к терапии ингибиторами протонной помпы / В.О. Кайбышева, А.С. Трухманов, В.Т. Ивашкин // РЖГГК. — 2011. — Т. ХХI, № 4. — С. 4-13.

Лапина Т.Л. Лечение эрозивно-язвенных поражений желудка и двенадцатиперстной кишки / Т.Л. Лапина // РМЖ. — 2001. — № 13. — С. 14.

Кондратенко П.Г. Профилактика рецидива гастродуоденального кровотечения язвенной этиологии / П.Г. Кондратенко, Е.Е. Раденко // Украинский журнал хирургии. — 2011. — № 4. — С. 129.

рН-метрия пищевода и желудка при заболеваниях верхних отделов пищеварительного тракта / [Рапопорт С.И., Лакшин А.А., Ракитин Б.В., Трифонов М.М. / Под ред. академика РАМН Ф.И. Комарова]. — М.: ИД Медпрактика-М, 2005. — 208 с.

Тогузова Д.А. Медикаментозная профилактика рецидивов гастродуоденальных кровотечений при язвенной болезни: Автореф. дис... канд. мед. наук: спец 14.01.03 «хирургия» / Д.А. Тогузова. — Москва, 1997. — 23 с.

Шептулин А.А. Современные возможности и перспективы лечения резистентных форм гастроэзофагеальной рефлюксной болезни / А.А. Шептулин // Рос. журн. гастроэнтерол., гепатол., колопроктол. — 2010. — № 6. — С. 81-85.

Fass R. Management of heartburn not responding to proton pump inhibitors / R. Fass, D. Sifrim // Gut. — 2009. — Vol. 58. — P. 295-309.

Hwai-Jeng Lin. A prospective randomized trial showing that omeprazole prevents rebleeding in patients with bleeding peptic ulcers / Hwai-Jeng Lin, Wen-Ching Lo, Fa-Yauh Lee // Courtesy Archives of Internal Medicine. — 1998. — № 54. — Р. 58.

Leontiadis G.I. Systematic review and meta-analysis: proton-pump inhibitor treatment for ulcer bleeding reduces transfusion requirements and hospital stay — results from the Cochrane Collaboration / G.I. Leontiadis, V.K. Sharma, C.W. Howden // Aliment. Pharmacol. Ther. — 2005. — № 169. — Р. 74.

Leontiadis G.I. Systematic review and meta-analysis: enhanced efficacy of proton-pump inhibitor therapy for peptic ulcer bleeding in Asia — a post hoc analysis from the Cochrane Collaboration / G.I. Leontiadis, V.K. Sharma, C.W. Howden // Aliment. Pharmacol. Ther. — 2005. — № 1055. — Р. 61.

Meta-analysis of proton pump inhibitors in treatment of bleeding peptic ulcers / P.J. Zed, P.S. Loewen, R.S. Slavik, C.A. Marra // Ann. Pharmacother. — 2001. — № 1528. — Р. 34.

Orr W.C. Reflux events and sleep: are we vulnerable? / W.C. Orr // Curr. Gastroenterol. Rep. — 2006. — Vol. 8. — P. 202-207.

Sharma V.K. Intravenous proton pump inhibitors for peptic ulcer hemorrhage: meta-analysis of randomised controlled trials allowing endoscopic treatment / V.K. Sharma, G.I. Leontiadis, C.W. Howden // Gastroenterology. — 2001. — № 120. — Р. 248.




DOI: https://doi.org/10.22141/1997-2938.2.21.2013.87524

Refbacks

  • There are currently no refbacks.


Copyright (c) 2016 UKRAINIAN JOURNAL OF SURGERY

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

 

© Publishing House Zaslavsky, 1997-2017

 

 Яндекс.МетрикаSeo анализ сайта Рейтинг@Mail.ru