Characteristic of Stomach Ulcers, Complicated by Bleeding

Abstract

Background. The benign nature of the gastric ulcer, determined during the initial video esophagogastroduodenoscopy (VEGD) in the presence of a hemorrhage or under the conditions of unstable hemostasis, is not a permanent characteristic of the pathological process, since most examinations do not include multifocal biopsy due to the danger of recurrent bleeding.Objectives: to evaluate the inflammatory changes, regenerative abilities of the peri-ulcer area and to predict malignization in the nearest post-hemorrhagic period.Methods. The work contains the examination data (VEGD, brush biopsy, morphological and immunohistochemical examinations) of 49 patients urgently admitted to the surgery with gastrointestinal bleeding, and further verification of gastric ulcer. Entry criteria were bleeding of the ulcer in the gastric mucosa, located in the antrum or the lesser curve with low risk of recurrent bleeding (Forrest 2C), presence of Helicobacter pylori.Results. Brush biopsy allowed determining the benign nature of ulcerative lesions in 98 % of the patients during the two-day period following the first VEGD. Morphological study revealed dysplasia at the edge of ulcerative lesion with first signs of regeneration in 14.3 % of the patients. In the presence of dysplasia, we noted a vibrant response (+++) with COX-2 (×400), even if the ulcerous defect was smaller than 1.0 cm.Conclusion. Considering our results, it is necessary to develop a strict algorithm for dynamic follow-up of patients with gastric ulcers, complicated by bleeding.

Keywords

• gastric ulcer
• hemorrhage
• brush biopsy
• dysplasia
• cyclooxygenase