THE CAUSES OF ADVERSE TREATMENT RESULTS AND THE WAYS OF THEIR ELIMINATION IN BLEEDING FROM CHRONIC GASTRODUODENAL ULCERS

Abstract

The aim: Is to determine the main causes of adverse outcomes of the patients’ treatment with acute ulcerative gastroduodenal bleeding and to develop preventive measures to improve the quality of the patients’ treatment with this pathology. Materials and methods: A retrospective analysis of the treatment results of 1323 patients with bleeding of ulcerative etiology has been carried out. There are 375 patients with gastric ulcer (28.3%) and 948 patients (71.7%) with duodenal ulcer among them. The patients’ age ranged from 15 to 93 years old. Concomitant pathology was observed in 623 (47.1%) patients, the most common of which were coronary heart disease, chronic non-specific lung diseases and cerebrovascular diseases. Mild severity of blood loss was detected in 404 (30.5%) patients, moderate severity 693 (52.5%), severe 145 (10.9%) and extremely severe 81 (6.1%). Overall mortality was 5.9%, postoperative mortality 6.3%, the mortality in conservative treatment only 6.1%. Results: The main cause of the patients’ mortality with acute ulcerative gastroduodenal bleeding was decompensated hemorrhagic shock which developed at the prehospital stage in 45.3% and as a result of bleeding recurrence during treatment 44.2% of the patients. Inadequate drug therapy increases the risk of bleeding recurrence from 15.8 to 32.7%. The use of proton pump blockers and the combination of bolus and prolonged use of proton pump blockers allow to reduce the risk of bleeding recurrence by half (up to 6.8%). Conclusions: Endoscopic hemostasis in combination with the injection method with diathermocoagulation or thermal coagulation can be considered as full-fledged, and when performing endoscopic monitoring the preference should be given to coagulation methods of diathermo- and hydrodietermocoagulation.