Scientific journal
European Journal of Natural History
ISSN 2073-4972

EXAMINATION AND TREATMENT OF PATIENTS WITH HEMORRHAGE COMPLICATED GASTRO-DUODENAL ZONE PEPTIC ULCER DISEASE

Chernov V.N., Maslov A.I., Barokov E.M.
At the General Surgery Department of the RSMU and in the emergency hospital №2 of Rostov-on-Don during 1996-2007 163 patients with hemorrhage complicated gastro-duodenal zone acute ulcers had been observed. The cause of acute ulcers appearance in 40 patients were stressing situations, in 69 - primary trophic disturbances, in 18 - burn disease, in 36 - chemical agents (medicaments, alcohol). All the patients were hospitalized to the surgical hospital with bleeding in emergency order. 28 (11,1%) patients needed surgery (the retroclusion was performed in 16 cases of them). Two patients died of a heavy blood loss at the admission in the admitting office (late hospitalization). In the rest 133 (81,5%) patients the bleeding was stopped nonsurgically (endoscopy, medicaments).

At the admission the patients were prescribed the infusive, sedative, hemostatic, antiacid and antiulcer therapy. An important role was played by the transfusion of blood components and substitutes.

After bleeding control together with generally accepted clinico-laboratory studies the instrumental examinations were performed in accord with the methods developed at the Department:

  • endoscopic examination with the obligatory study of the esophageal junction and big duodenal nipple (BDN).
  • multiplanar X-ray examination;
  • study of the acid-forming function of the stomach with the help of computer pH-metria;
  • stomach motor function study;
  • Helicobacter pylori detection.

The findings testified that an X-ray examination against the continuing bleeding is inefficient. We carried out this study on the 3d day after bleeding control.

The gaster acid-forming function study data let us give up on the existing before the present day notion: hiper-, hipo-, and normal acidity. Only on the indication of acidity production, alkalizing function and vagus reaction on blockers we got 8 patient groups, only 3 of which needed a further surgeon observation with a view to a possible surgery.

The vegetative nervous system (VNS) investigation has allowed evaluating the state of the sympathetic nervous system, which promotes the stomach and duodenum mucous coat protective functions enhancement (myxopoiesis, carbonates development, etc.). On the state of hypothalamic centers of the VNS and peripheral terminals we have marked out 9 functional patient groups, which were also distributed according to the problem of treatment and prognosis.

The endoscopic studies let not only determine the ulcer focalization, sizes and state, but detect the hiatal hernia (HH) presence, the BDN state, malignant transformations suspect zones, etc. I.e. it allows detecting the pathology, on which to a large extent the choice of surgical tactics depends. So, for example, with the HH presence one doesn´t have to expect the intended result from a stomach and duodenum operation without the esophageal hiatus correction.

An important role in the gastro-duodenal zone ulcer therapeutic approach determination is played by the stomach motor function. So, at dismotility and other causes (BDN pathology) it is not possible to restore the physiological food passage and, therefore, it is impossible expect a demandable effect from the gastric resection.

The detection of Helicobacter pylori by biochemical and anatomical methods is obligate. Among qualitative biochemical CLO-tests the "express-urea" one, produced in the Rostov dealer Scientific Production Enterprise "Source System", was used. This method differs from other tests by the following properties: the urea activity determination result is evaluated in 5-7 minutes after gastrobioptates being placed into the test solution; after the evaluation of Helicobacter pylori contamination of the gastroduodenal mucous the biopsy samples placing into other solutions for the following anatomic study is possible.

The obtained findings on every patient (136 persons) having been treated according to the abovementioned scheme have let us prognosticate that only 14% of them will need surgical service in the future. All the patients were put into dispensary observation list, got antiulcer prophylactic treatment and examination (endoscopy, pH-metria, the VNS and gastric motor activity) regularly. Remote results from 4 to 11 years testified that only 6 persons from this group were subject to surgical service.

Comparing the hemorrhage complicated gastroduodenal zone peptic ulcer disease patients´ examination and treatment results on a traditional scheme (170 persons) with the results of treatment of 163 patients examined and treated on our scheme, we have come to the conclusion that due to the examination and treatment of patients on our scheme we managed to decrease the number of surgeries by 52,2% and the lethality - by 21,4%. Thereat we think that the surgeries executed without strict indications and stomach functions features regard can lead to the development of a great number of pathological states demanding persistent conservative therapy or reoperations.

Thus, the hemorrhage complicated gastroduodenal zone acute peptic ulcer disease patients´ treatment results allow coming to the conclusion that to determine the treatment policy of such patients the application of these examination methods are obligate.

The article is admitted to the International Scientific Conference "Fundamental and applied research in medicine", China (Beijing), 26 November - 4 December, 2007, came to the editorial office on 09.11.07.