Gastroduodenal ulcer bleeding in patients with comorbid diseases: features of the clinical course and treatment tactics

Abstract

Introduction. Gastroduodenal ulcerative bleeding is one of the most frequent cases requiring emergency medical care. The prevalence of gastroduodenal bleeding reaches 170 cases per 100,000 of the adult population. Despite progress in the treatment of such patients, the overall mortality rate for ulcerative bleeding is 10–15%, and the mortality rate for surgical interventions at the height of bleeding is 20–40%. Severe comorbid diseases in 60–90% of patients worsen their condition and significantly increase the risk of mortality after surgical intervention in acute ulcerative gastroduodenal bleeding. The purpose of the study: to improve the immediate and long-term results of treatment of patients with gastrointestinal ulcerative bleeding in conditions of polymorbidity by studying the features of the clinical course and tactics of treatment of gastroduodenal ulcerative bleeding. Materials and methods. An analysis of the results of clinical examination and treatment of 215 patients with ulcerative gastroduodenal bleeding was carried out. The average age of the patients was 51.4±0.54 years. There were 116 (53.9%) men and 99 (46.1%) women. The main observation group included 163 (75.8%) patients with bleeding from acute and chronic ulcers of the stomach and duodenum with severe comorbid diseases. The control group consisted of 52 (24.2%) patients with gastroduodenal bleeding from acute and chronic gastric and duodenal ulcers without severe comorbid diseases. Bleeding was diagnosed in all patients based on clinical signs and fibroesophagogastroduodenoscopy. To stop bleeding, we used methods of non-operative (endoscopic + medication) and operative hemostasis. Results and their discussion. In patients of the main group, the symptoms of gastrointestinal ulcerative bleeding were atypical, and the leading sign of bleeding in this category of patients was the presence of melena – in 88.4% of cases. In 14 (8.6%) patients with comorbid diseases due to an atypical clinical picture, gastroduodenal bleeding was diagnosed untimely, which subsequently affected the quality of medical care. For 206 (95.8%) patients with acute gastroduodenal ulcerative bleeding, the main direction of treatment was endoscopic hemostasis and prescribing courses of hemostatic therapy. Among the endoscopic methods of stopping bleeding, circumcision of the bleeding vessel with vasoconstrictor and sclerosing solutions was performed in 74 (35.9%) patients; clipping was used in 68 (33%) patients; argon plasma coagulation – in 36 (17.5%) and the use of combined methods – in 28 (13.6%) patients. Gastroduodenal ulcerative bleedings that could not be stopped by medication and endoscopic methods of hemostasis, as well as recurrent bleedings, were subject to surgical correction. 38 (17.67%) patients underwent the following operations: ulcer excision – in 17 (44.74%) patients, ulcer exteriorization – in 8 (21.1%) patients followed by duodenoplasty and pyloroduodenoplasty, sectoral resection of the stomach – in 6 (15.79%), gastric resection according to Billroth-I – in 4 (10.53%) patients and stitching of an ulcer – in 3 (7.89%) patients. Conclusions. The clinical symptomatology of gastrointestinal ulcerative bleeding in patients with comorbid diseases is atypical and in 8.6% of cases it is diagnosed late. Complex treatment of ulcerative gastroduodenal bleeding in patients with comorbid diseases with the use of modern methods of endohemostasis and conservative therapy in most cases allows to achieve the final stop of bleeding.