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”Acute gastroduodenal bleeding ulcer: etiopathogenetical, clinico-endoscopical features, and treatment


Author: Ghenadie Mocanu
Degree:doctor of medicine
Speciality: 14.00.27 - Surgery
Year:2007
Scientific adviser: Eugen Guţu
doctor habilitat, professor, State University of Medicine and Pharmacy "Nicolae Testemitanu"
Institution:
Scientific council:

Status

The thesis was presented on the 31 January, 2007
Approved by NCAA on the 1 March, 2007

Abstract

Adobe PDF document0.43 Mb / in romanian

Keywords

acute gastroduodenal ulcer – hemorrhage – etiology – pathogenesis – antisecretory treatment – surgery

Summary

The aim of the study was to increase the efficiency of treatment in acute gastroduodenal bleeding ulcer, following investigation of their etiopathogenetical, clinical and endoscopical features.

The study is based on analysis of clinical, endoscopical and laboratory data, and also on evaluation of treatment results of 114 patients with acute gastroduodenal bleeding ulcer. It was proved, that severity of hemorrhage from acute mucosal lesion, characterized by clinical, endoscopical and laboratory criteria, depends directly on etiology and morphological features of acute gastroduodenal bleeding ulcer. It was shown, that the high gastric acidity in association with disturbance of intragastric protective mechanisms determines development of acute gastroduodenal bleeding ulcers, as well as a higher severity of initial blood loss and negative evolution of bleeding episode, decreasing the efficiency of antisecretory and endoscopic treatment. It was shown, that the main predispose background for development of acute gastroduodenal bleeding ulcers in case of exogenous injuries (aspirin, NSAIDs and etanol) is presented by active cronic gastritis, first of all conditioned by infection of H.pylori. The prospective study is proved a low efficiency of standard doses of antisecretory drugs for maintainance of high stable intragastric pH level in patients with acute gastroduodenal bleeding ulcers. It was established, that only individual increase of the antisecretory drugs doses, approximately in 1,5-2 folds comparative with standard ones, based on results of 24-hours monitoring intragastric pH-metry, allows to obtain the stable suppression of gastric acidity and to optimize the processes of spontaneous hemostasis in acute gastroduodenal ulcer. During the study the high efficiency and safety of wide use of human thrombin and adrenalin injection for endoscopic hemostasis in acute gastroduodenal bleeding ulcer was proved. It was established, that the factors, which can decrease success of endoscopic therapy are active bleeding, major initial blood loss and large diameter of the ulcer. So, this study determined and described the most characteristic clinical, endoscopical, laboratory and morphological features of acute gastroduodenal bleeding ulcer, established their relationship with etiology of disease, and elaborated the effective methods of treatment, based mainly on the large use of endoscopic hemostasis and individual protocols of antisecretory therapy and H.pylori eradication.