Authors
Valeev M.V.1, Timerbulatov SH.V.2
1 Central District Hospital of Beloretsk, Beloretsk
2 Bashkir State Medical University, Ufa
Abstract
Aims. To analyze the results of treatment of patients with nonvariceal upper gastrointestinal bleeding in the conditions of the central district hospital (in the absence of technical capabilities for endoscopic hemostasis).
Methods. The analysis of the treatment results of 472 patients with nonvariceal upper gastrointestinal bleeding who were hospitalized in the Beloretsk Central District Hospital from 2008 to 2018 was carried out. During this period, the clinic lacked technical capabilities for performing endoscopic hemostasis.
Results. As a source of bleeding, the peptic ulcers (50.8%) and Mallory-Weiss tears (37.3%) take the leading place. Following are the erosive lesions of the esophagus, stomach and duodenum (9.3%). Surgical treatment for peptic ulcer bleeding was performed in 22.9% of cases, with Mallory-Weiss tears — in 4%. Rebleeding was characteristic of peptic ulcer disease (21.7%) and Mallory-Weiss tears (5.7%). Mortality with peptic ulcer bleeding was 6.3%, with Mallory-Weiss tears — 1.7%.
Conclusion. 1. Of the whole variety of nonvariceal upper gastrointestinal bleeding, ulcer bleeding and Mallory-Weiss tears remain the most relevant for the surgeon today. 2. Rebleeding with peptic ulcer and Mallory-Weiss tears is one of the main risk factors for the development of a fatal outcome, increasing mortality tenfold. 3. In the absence of endoscopic hemostasis in the treatment of ulcerative bleeding, the most preferred is active surgical tactics. 4. An unusual cause of the development of Mallory-Weiss tears is an exacerbation of peptic ulcer.
Keywords: upper gastrointestinal bleeding, the peptic ulcer bleeding, Mallory-Weiss tear.
References
1. Hearnshaw SA, Logan RF, Lowe D, et al. Acute upper gastrointestinal bleeding in UK: patients characteristics, diagnoses and outcomes in the 2007 UK audit. Gut. 2011;60(10):1327–1335. Doi: 10.1136/gut.2010.228437.
2. Chernov AV, Polubkova GV, Cherednikov EE, et al. Diagnosis and treatment of patient with gastroduodenal bleeding in specialized center. Voronezh: Voronezhskaya gosudarstvennaya meditsinskaya akademiya im. N.N. Burdenko; 2014. (In Russ).
3. Leerdam ME. Epidemiology of acute upper gastrointestinal bleeding. Best Pract Res Clin Gastroenterol. 2008;22(2):209–224. Doi: 10.1016/j.bpg. 2007.10.011.
4. Gostishchev VK, Evseev MA. Ostrye gastroduodenal’nye yazvennye krovotecheniya: ot strategicheskikh kontseptsii k lechebnoi taktike. Moscow: Anta-Eko; 2005. (In Russ).
5. Lu Y, Barkun AN, Martel M. Adherence to guidelines: a national audit of the management of acute upper gastrointestinal bleeding. The REASON registry. Can J Gastroenterol Hepatol. 2014;28(9):495–501. Doi: 10.1155/2014/252307.
6. Saltzman JR. Advances and improvements in the management of upper gastrointestinal bleeding. Gastrointest Endosc Clin N Am. 2015;25(3):15–16. Doi: 10.1016/j.giec.2015.04.001.
7. Monteiro S, Goncalves TC, Magalhaes J, et al. Upper gastrointestinal bleeding risk scores: who, when and why? World J Gastroint Pathophysiol. 2016;7(1):86–96. Doi: 10.4291/wjgp.v7.i1.86.
8. Abougergi MS, Travis AC, Saltzman JR. The in-hospital mortality rate for upper GI hemorrhage has decreased over 2 decades in the United States: a nationwide analysis. Gastrointest Endosc. 2015;81(4):882–888. Doi: 10.1016/j.gie.2014.09.027.
9. Stupin VA, Baglaenko MV, Kan V, et al. Lethality after gastroduodenal ulcer bleeding. Khirurgiia. 2013;(5):31–35. (In Russ).
10. Zdzitovetskii DE, Borisov RN, Kovalenko OV Rezul’taty lecheniya bol’nykh s krovotecheniyami iz verkhnikh otdelov zheludochno-kishechnogo trakta po dannym KGBUZ KMKBSMP im. N.S. Karpovicha za 3 goda. In: (Conference proceedigs) Konferentsiya «Aktual’nye voprosy sovremennoi khirurgii»; 2018 mar 14-15; Krasnoyarsk. Krasnoyarsk: Verso; 2018. pp. 121–125. (In Russ).
11. Barkun A, Sabbah S, Enns R, et al. The Canadian Registry of Nonvariceal Upper Gastrointestinal Bleeding and Endoscopy(RUGBE): endoscopic hemostasis and proton pump inhibition are associated with improved outcomes in a real-life setting. Am J Gastroenterol. 2004;99(7):1238–1246. Doi: 10.1111/j.1572-0241.2004.30272.x.
12. Del Piano M, Bianco MA, Cipolletta L, et al. The «Prometeo» study: online collection of clinical data and outcomes of Italian patients with acute nonvariceal upper gastrointestinal bleeding. J Clin Gastroenterol. 2013;47(4):e33–e37. Doi: 10.1097/mcg.0b013e3182617dcc.
13. van Leerdam ME, Vreeburg EM, Rauws EA, et al. Acute upper GI bleeding: did anything change? Time trend analysis of incidence and outcome of acute upper GI bleeding between 1993/1994 and 2000. Am J Gastroenterol. 2003;98(7):1494–1499. Doi: 10.1111/j.1572-0241.2003.07517.x.
14. Khunafin SN, Fedorov SV, Petrov YuV, et al. Gastroduodenal ulcerous hemorrhages. Permskii meditsinskii zhurnal. 2014;31(5):17–21. (In Russ).
15. Jimenez Rosales R, Martinez-Cara JG, Vadillo-Calles F, et al. Analysis of rebleeding in cases of an upper gastrointestinal bleed in a single center series. Rev Esp Enferm Dig. 2018;111(3):189–192. Doi: 10.17235/reed.2018.5702/2018.
16. Khamaysi I, Gralnek IM. Acute upper gastrointestinal bleeding (UGIB) — initial evaluation and management. Best Pract Res Clin Gastroenterol. 2013;27(5):633–638. Doi: 10.1016/j.bpg.2013.09.002.
17. Forrest JA, Finlayson ND, Shearman DJ. Endoscopy in gastrointestinal bleeding. Lancet. 1974;2(7877):394–397. Doi: 10.1016/s0140-6736(74)91770-x.
18. Korovin AJ, Maskin SS, Turkin DV, et al. Videolaparoscopy in diagnosis and treatment of abdominal pathology with clinical manifestations of acute appendicitis. Vestnik khirurgicheskoi gastroehnterologii. 2017;(1):41–45. (In Russ).
19. Lavreshin PM, Brusnev LA, Gorbunkov VYa, et al. Experience in the treatment of gastroduodenal bleeding ulcer etiology in a city hospital. Bulletin of Pirogov National Medical & Surgical Center. 2019;14(2):42–44. (In Russ).
20. Jairath V, Martel M, Logan RF, Barkun AN. Why do mortality rates for nonvariceal upper gastrointestinal bleeding differ around the world? A systematic review of cohort studies. Can J Gastroenterol. 2012;26(8):537–543. Doi: 10.1155/2012/862905.
