ANALYSIS OF TREATMENT OF PATIENTS WITH ACUTE BLEEDING GASTRIC ULCERS

A.A. AZIMOV, Y.R. MALIKOV, B.A. YANGIEV, O.A. MADAMINOV

Branch of the Republican Scientific Center for Emergency Medical Care,

Navoi, UZBEKISTAN

Purpose – improvement of the results of treatment of patients with bleeding gastric ulcers (BGU) with the use of antisecretory drugs at the stages of urgent medical assistance. The analysis of the results of examination and treatment of 248 patients with acute bleeding gastric ulcers, of whom 34 (13.7%) were in the first (1990-2000), 214 (86.3%) - in the second period (2001-2009). Bleeding from acute gastric ulcers occurred against the background of the non-underlying disease in 102 (41.1%) patients. Among them stress factors caused bleeding in 16 (6.5%) cases. Intake of nonsteroid anti-inflammatory drugs (NSAIDs) led to bleeding in 72 (29.0%) cases. At the same time, there was revealed reliable correlation between the following parameters: intake of NSAIDs and the number of ulcers (r_s = +0,480; P <0,0001), intake of NSAIDs and recurrent bleeding (r_s = +0,246; P <0,0001). Relation between NSAID in anamnesis and character of the course of GUD was significantly higher in acute BGU (r_s = +0,614; P = 0,025), than in chronic (r_s = +0,218; P = 0,154). Pharmacological prevention of recurrences of acute BGU in 102 (41.1%) patients, occurred against the background of non-underlying disease was carried out by antisecretory drugs. Among these patients, drugs of H₂-blockers group (quamatel parenterally 40 mg/day) were used in 46 (45.1%), proton pump inhibitors (PPIs) (losec parenterally 40 mg/day) - in 23 (22.5%) patients. The remaining 33 (32.4%) of 102 patients were not applied prophylactic pharmacotherapy with antisecretory drugs. The efficiency criterion of therapeutic effect of antisecretory drugs in acute BGU was the lack of recurrent hemorrhage and stability of homeostasis according to coagulation. Disturbance of the stability of hemostasis and recurrent bleeding against the background of antisecretory therapy, occurred in 19 (41.3%) patients with the application of H₂-blockers, and in 1 (4.3%) case of recurrence – with the use of PPIs. In our observations, the cause of death in patients with symptomatic hemorrhage from BGU in 76.9% of cases was the underlying disease. In 3 (2.9%) of 14 (13.7%) patients that had fatal outcome, acute gastroduodenal erosions and ulcers develop against the background of their prophylactics, and in 33 (32.4%) cases, prophylactics was not performed (the ratio of patients with prophylactics / without prophylactics - 1 / 3,1). In this case, the difference between the groups of patients with fatal outcomes with and without prophylaxis was significantly great (χ2 = 9,293, df = 1, P = 0,002).

PARTICIPATION OF H.PYLORI SEEN IN STOMACH AND DUODENUM IN THE CHRONICAL CALCULUS-FREE CHOLECYSTITIS

A.R.BAGHIROVA

Scientific Center of Surgery after acad. M.A. Topchubashov, Baku, AZERBAIJAN

85 patients suffering from chronical calculus-free cholecystitis (basic group) during anomalous of the gallbladder were our examination objects. 66 (77,6 %) cases from 85 patients with chronical calculus-free cholecystitis chronical diseases the esophagus, stomach and duodenum were recorded.

85 patients suffering from chronical calculus-free cholecystitis were examined. H.pylori was revealed on 73 patients (85,8 %) in the cytological examination of the biopsy material, which got form the mucous membrane of the stomach and duodenum during FQDS examination of 85 patients who have chronical calculus-free cholecystitis, anomalous of the gallbladder. Fraction duodenal probe was done to all the patients. The bile was researched macroscopic, microscopic and microbiological in the result of fraction duodenal probe.

During anomalous of the gallbladder, we decided to define H.pylori to infect to the gallbladder 85 patients, who have chronical calculus-free cholecystitis. By this purpose, we have explored the bile to the H.pylori, which got at the result of duodenal probe. It was affirmed having H.pylori on 71 patients (97,2 %) in the B portion which got form duodenal probe of 73 patients defined H.pylori in the mucous membrane of the stomach and duodenum. It was interesting that, there wasn’t defined H.pylori in the bile which got form duodenal probe on none of 12 patients, who weren’t defined H.pylori on the stomach and duodenum. Together with the H.pylori leucocyte infiltration, proliferation and metaplastic cells existed in the content of bile.

According to the aforesaid facts we can come to the conclusion that it is possible to continue the activity of the gallbladder infected to the internal of the H.pylori, which anomalous form infected stomach and duodenum with H.pylori. Generally in the normal condition, bile is the aggressive sphere for H.pylori. So H.pylori infection existed in the stomach and duodenum can have infecting ability to the gallbladder probably as changing physical and chemical content of bile in order to haemostasia and bacteriosid feature of the gallbladder and during deformation of gallbladder.

Date: 2014-12-28; view: 921