Potential humoral markers of gastric and duodenal stress ulcers accompanied by concomitant head injury

Aim. To evaluate the significance of a number of humoral indicators in gastrointestinal bleeding at various stages of severe concomitant head injury.

Methods. The study included 347 patients with severe head injuries (brain contusion, intracerebral hemorrhage) associated with fractures of the extremities and pelvis (215 patients), abdominal organs injuries (75 patients), chest and lung injuries (57 patients). Samples of blood and stomach contents were taken on the 1st, 3rd, 5th, 8th, 9th, 12th, 15th and 18th days after the injury. Esophagogastroduodenoscopy was performed on the 3rd, 5th, 7th and 10th day after the trauma. Anti-streptolysin O, antihyaluronidase, C-reactive protein, sialic acids levels were determined by serum titration and precipitate formation.

Results. On the 1st day, anti-streptolysin O level exceeded normal values (by 4.1±1.3 IU/ml), reaching a maximum value by 8-10th day (exceeding the normal range by 61.3±1.7 IU/ml) with further decrease after the 15th day. Antihyaluronidase level was permanently increased from the 5th day of observation. C-reactive protein level was higher than normal from the first day of study (0.1±0.17 mg/l), with further upward trend, reaching its peak on day 9, indicating continuous inflammation. Sialic acids level in the first days was twice as high as the normal level, and remained almost at the same level until the end of the study. Endoscopic examinations in 21 patients with gastrointestinal bleeding showed that in 11 (52.4%) cases, the source of bleeding were acute gastric and duodenal erosions and ulcers, in 5 (23.8%) cases - chronic gastric and duodenal ulcers, in 5 (23.8%) cases bleeding occurred due to exacerbation of chronic duodenal ulcer.

Conclusion. Changes in serum anti-streptolysin O, antihyaluronidase, sialic acids levels in patients with severe head injuries, combined with other injuries may reflect the pathogenesis of acute gastroduodenal erosions and ulcers and be considered as the markers for their development.