The original scale prediction of recurrence risk of gastroduodenal ulcer bleeding

Research goal - to examine the effectiveness of active-individualized tactics in treatment of chronic gastric and duodenal ulcers. Material and methods. Analysis of treatment of 251 patients with chronic gastric and duodenal ulcer bleeding was conducted. Duodenal ulcer bleeding was present in 202 cases (80,5%), gastric ulcers were the reason of bleeding in 49 cases (19,5%). Treatment conducted according to principles of active-individualized tactics. Results. The provided characteristics and the acquired results were presented according to the fundamental components of active-individualized tactics in treatment of gastric and duodenal ulcers. Diagnostic and treatment abilities of endoscopy were determined, an unique scale of bleeding relapse risk was presented, the time limits and main indications for surgery were explained,, the role of bleeding relapse was emphasized as crucial in forming the main results of treatment of patients with bleeding gastric and duodenal ulcers. Conclusion. At present time, active-individualized tactics should be used for treatment of gastric and duodenal ulcer bleeding.

APPLICATION OF MODERN METHODS OF ENDOSCOPIC HАEMOSTASIS IN THE TREATMENT OF GASTRODUODENAL ULCER BLEEDING

Summary. The aim of the study is to improve the results of treatment of patients with ulcerative gastroduodenal bleeding by using the methods of endoscopic hаemostasis. Materials and research methods. The results of endoscopic hаemostasis of 153 patients who were treated in the surgical department of the “Regional Clinical Hospital” were analyzed. Patients were examined clinically, laboratory and instrumental. Results and its discussion. For Forrest 1a, b bleeding, endoscopic clipping was used in 16 (10.4 %) patients with a visualized vessel in the bottom of the ulcer. In the studied patients of this group, there were no relapses of bleeding. Diathermy coagulation was used in 42 (27.5 %) patients. Recurrent bleeding was observed in 6 patients. Submucosal infiltration was performed in 37 (24.2 %) patients with ulcerative bleeding. Repeated bleeding was recorded in 9 patients within the next 3 hours after the intervention and in 7 patients during the first days after endoscopic hаemostasis. Combinations of endoscopic methods of hаemostasis were used in 58 (37.9 %) patients. Conclusions. The use of modern methods of endoscopic hаemostasis followed by adequate pharmacotherapy in most cases allows achieving a final stop of bleeding. Patients with a high risk of recurrent bleeding and a low surgical and anesthetic risk after successful endoscopic hаemostasis are shown surgical intervention before the development of recurrent bleeding.

Risk Factor Analysis And Method Development For Predicting The Recurrence Of Gastroduodenal Ulcer Bleeding

Objective — To clarify clinical, laboratory and endoscopic signs of a high recurrence risk of gastroduodenal ulcer bleeding (GDUB) and to develop a multifactorial method for its prediction. Material and Methods — The research was completed over 2019-2020. The study took place in two stages. At the first stage, 409 patients with GDUB, who were treated at the emergency surgical department of Saratov City Clinical Hospital No. 6 from 1991 to 2000, were included in the study. During that time, endoscopic hemostasis therapy was used in a few cases, while modern antisecretory therapy has not yet been developed and carried out. Two groups of patients were compared: with recurrent bleeding (104 patients) and without recurrent bleeding (305 patients). At the second stage, a retrospective analysis of the outcomes of treating 126 patients with GDUB, cared for at the clinic from 2001 to 2009, was carried out. During this period of time, assistance for this pathology was the most complete and matched all current standards. The analysis included 63 patients with recurrent bleeding and 63 patients without recurrent bleeding. We conducted a comparative analysis of the developed method for predicting bleeding recurrence versus the classifications by J.A. Forrest (1974) and G.P. Giderim (1992) in our original modification. Results — At the first stage of the study, the most significant signs for predicting recurrent bleeding were identified as unstable hemodynamics, severity of blood loss, nature of vomiting, presence of concomitant pathology, state of the ulcer surface sensu J.A. Forrest; and localization, size and depth of the ulcer. We determined their informative value in assessing the risk of recurrent bleeding and developed a novel method of its prediction. Taken alone, each of nine predictive signs has a correlation, comparable in the magnitude with patient allocation into each group (based on the absolute value of gamma, ranging 0.49–0.66); the prediction accuracy is 60–74%, with a positive predictive value of 35-49%. The measure of the gamma relationship for splitting patients among groups by the original method based on nine features in conjunction with each other was -0.79 (p<0.001). Conclusion — Prediction of recurrent bleeding by one or two signs is inferior in informational content (although insignificantly) to the multifactorial method. The developed method for predicting the recurrence of ulcer bleeding from nine signs has an optimal ratio of sensitivity and specificity, which ensures a prediction accuracy of over 70% and a positive predictive value of 68.9%.

THE EFFICACY OF RECOMBINANT INTERLEUKIN-1Β IN SURGICAL TREATMENT OF ACUTE ULCERATIVE GASTRODUODENAL BLEEDINGS

There was reported the results of the use of recombinant interleukin-1β in basic conservative measures in the surgical treatment of acute gastroduodenal ulcer bleeding. Gastric ulcer were in 20 patients, duodenal ulcer in 84 patients and combined ulcers in 16 patients. According to А.А. Шалимов hospitalized patients with mild blood loss were 27, moderate degree - 62 and severe degree - 31 patients. According to J. Forrest, 29 showed active bleeding (F Ia, F Ib), in 67 - unstable hemostasis (F IIa, F IIb, F IIc) and in 24 - F III. Within the framework of differentiated individual-active tactics, patients were operated in emergency (21), urgent (38), delayed (35), and 26 people underwent early planned operations. Patients in the main group (63) after the operation, was included recombinant interleukin-1β to the basic therapeutic measures additionally, taking into account the degree of blood loss and immune disorders. Patients of comparison group (57) before and after surgery received standard basic therapy without immunocorrection. In a comparative aspect, it has been proved that in postoperative period on the background of standard conservative measures, the use of recombinant interleukin-1β positively influences elimination of the secondary immunodeficiency and cytokine imbalance significantly improves the results of surgical treatment.