Treatment options for acute complications of gastroduodenal ulcer

Abstract

Introduction. The gastroduodenal ulcer holds the first place in the structure of the digestive tract morbidity. Diversification of anti-ulcer high end drugs with different action mechanism constituted the base for decrease of number of patients who suffered from gastroduodenal ulcer. This also has influenced the frequency of acute complications of gastroduodenal ulcer such as perforation and bleeding ulcer. Aim of the study. To study the treatment options for gastroduodenal ulcer acute complications. Materials and methods. A retrospective study based on patients treated for gastroduodenal ulcer who were hospitalized during the period 2016-2017 in CMH no.1 was performed. Results. During a year in General Surgery Clinic of PMSI CMH no.1 there were treated 106 (94.6%) patients with upper digestive bleeding and 6 (5.4%) patients who were suffering of gastroduodenal perforation. From those 106 patients with bleeding who were treated in the clinic 41 (38.6%) had peptic ulcer as the origin of bleeding. All the patients with digestive bleeding underwent diagnostic endoscopy. In 41 patients with ulcer bleeding the primary emergency endoscopy revealed the following division of bleeding according to Forrest classification: Forrest IA–3 (7.3%) patients, IB in 8 (19.5%) cases, IIA–10 (24.3%) patients, IIB 15 (36.5%), IIC in 6 (14.6%) and Forrest III in 3 (2.6%) patients. In case of active bleedings and in patients with signs of stigmata of recent bleeding, the primary diagnostic endoscopy was also curative. In 36 (33.9%) patients the primary endoscopic haemostasis was successful and in 5 (4.7%) another endoscopy with repeated haemostasis was necessary. In 3 (2.8%) cases the repeated haemostasis failed and the patients underwent emergency surgery because of continuous bleeding. Thus, during a year, the patients who suffered from perforated ulcer and upper digestive bleeding underwent surgical treatment 10 patients - 6 (60%) for perforation and 4 (40%) for bleeding. Conclusions. Currently, the surgical treatment is rarely used for the ulcer disease, mostly for cases of acute complications of ulcer which are the perforation and massive bleeding which is not possible to be treated by endoscopy.