Scientific journal
European Journal of Natural History
ISSN 2073-4972

PROGNOSTIC METHODS OF ULCEROUS GASTRODUODENAL HEMORRHAGE RELAPSE

Kulikovsky V.F., Parkhomenko I.E.
There is a sufficient set of variants of early ulcer hemorrhage relapse (further bleeding) prognostication which is one of the major factors in treatment of UGHR patients. In general, all of them are based on clinical experience, the surgeon´s intuition, or on the use of objective endoscopic findings with the application of new complex technologies: endosonography, measuring of mucous coat impedance, redox-potential, etc., which are inconvenient for wide application. There is the authors´ opinion, that the recurrent hemorrhage prognostication accuracy based only on endoscopic picture and the blood loss severity has reached the maximum and cannot exceed 70 % (1).

The purpose of our work was to create an analytical system, capable to assist an attending physician in solving tactical questions of UGHR disease management, and based on the bleeding relapse prognostication.

Materials and methods

A retrospective randomized analysis of 411 UGHR case records was carried out by us, the patients having been treated in clinical hospitals of regional centers from 2000 to 2005.  A formalized case record (questionnaire of findings) with the unified set of elements, consisting of 125 items was composed. The elements´ list (signs, symptoms, laboratory and instrumental data) was being made empirically on the basis of clinical practice. According to the questionnaire an "Electronic base of UGHR patients for risk factors disclosure in the prognostication of bleeding outcomes" was made.  On each sign of the formalized case record its importance concerning the prognostication purpose - bleeding relapse risk, was defined (2.)  The significance or reliability of a sign (factor) was defined by means of statistical nonparametric criterion c2 (chi-square). The most significant factors on bleeding relapse risk became 84 ones. Among them: the age of 45 years and older, primary hemorrhage episode in a hospital, admission in terms till 5 days, repeated vomiting with blood, black liquid defecations more than 4 times, gastrointestinal hemorrhage in anamnesis, post-surgical hemorrhage, nonsteroidal antiinflamatory drugs intake, organ failure, oedemata, icterus, hemoglobin at the admission less than 70 g/l, ulcer defect size of 8 mm and more, ulcer defect depth more than 5 mm with possible penetration, subcompensated stenosis of duodenal cap with ulcer defect localization in it - the source of  bleeding, any protracted bleeding when carrying out an electro-gastroduodenoscopy, the transfused plasma-substituting solutions volume more than 7,3 liters, ignoring eradication therapy, etc.

On the basis of the risk factors importance a computer program was developed: "The program of risk factors search for bleeding dynamics prognostication of patients suffering from ulcer gastroduodenal hemorrhage". The program can be applied in medical establishments of regional and city types, equipped by a minimum of the diagnostic instrumentation and computer technics. Using the patient´s checkup results and the disease anamnesis, the results of laboratory and instrumental researches, the obtained data are entered into the program, and after computer processing the doctor receives authentic enough expert opinions on the bleeding relapse risk. Predicting the bleeding relapse threat, the program helps to solve the problem of the necessity to carry out preventive haemostatic actions. It is necessary to recognize, that the conclusions based on the prognostic results, have recommendatory character because the prognostication effectiveness is high enough though, but does not reach a hundred per cent. The responsibility for the treatment outcome is assigned to surgeons; that is why they finally define the choice of medical tactics at UGHR patients.

Conclusions

  1. The knowledge of bleeding relapse risk factors allows assuming its probability with sufficient reliability.
  2. Program prognostication helps the attending physician to solve the problem of rationality of carrying out emergency preventive haemostatic actions, and aims at the necessity of more skilled experts´ consultations.

Literature

  1. Shapkin J.G., Potakhin S.N., Belikov A.V., etc. "Diagnostics of peptic ulcer pre-recurrent syndrome"// "Surgeon Reporter"- 2004, №3, pp. 43-46.
  2. Kumar Amrish "The choice of medical tactics at patients younger than 60 suffering from chronic bleeding gastric ulcer" // Autoabstract  Thesis ... Master of Medical Sciences. -Saint-Petersburg, 2004, p.21.

The article is admitted to the International Scientific Conference " Higher School Research ", Spain, Morocco, Tenerife, Madera - cruise, 2006, December  2-12; came to the editorial office on 01.11.06