Modern Clinical and Epidemiological Features and New Technological Possibilities in the Treatment of Bleeding Gastroduodenal Ulcers

Abstract

The aim of this research was to study the current clinical and epidemiological features of ulcerative gastroduodenal bleeding (GDB) and to evaluate the outcomes of using new technological approaches in patients with bleeding from acute (symptomatic) and chronic (peptic ulcer disease) gastroduodenal ulcers (GDUs). Methods and Results: The present study involved 221 patients with bleeding GDUs. Depending on the source of bleeding, all patients were divided into 2 groups. Group 1 included 143 patients with acute symptomatic GDUs; Group 2 consisted of 78 patients with peptic ulcer disease complicated by bleeding. In the complex treatment of patients of all the studied groups, an individual approach was used that included the innovative technologies of endoscopic cytoprotective treatment of GDB, based on the combined use of traditional means of EH in combination with the use of endoscopic pneumoinsufflation of biologically active drainage sorbent of a new generation Aseptisorb-D and powdered hemostatic Zhelplastan. Our analysis showed that acute symptomatic GDUs prevailed in the structure of GDB – 143(64.7%) patients; PUD complicated by bleeding was diagnosed in 78(35.3%) cases. The use of new technological approaches, including cytoprotective treatment of bleeding defects with biologically active draining sorbents of a new generation in combination with local hemostatics in the complex therapy of patients with ulcerative GDB, has significantly improved the results of treatment, which is confirmed by high rates of final hemostasis (95.0%), indicators of the effectiveness of primary EH in type FIA-IB (93.1%) and prevention of recurrence of FIIA-IIB bleeding (92.5%), with a low frequency of repeated bleeding (4.07%), emergency surgeries (2.7%), and mortality (3.2%). Conclusion: Currently, in the structure of ulcerative GDB, acute symptomatic GDUs are the most common – 64.7%, and the share of PUD complicated by bleeding accounts for 35.3% of cases only. PUD and GDUs complicated by bleeding have certain clinical and epidemiological features, which must be taken into account when treating these patients. Symptomatic GDUs are more difficult to treat, which shows the need to develop new complex technologies for their treatment.

Keywords

• bleeding gastroduodenal ulcers
• endoscopic hemostasis
• biologically active drainage sorbent