Kazan medical journalKazan medical journal0368-48142587-9359Eco-Vector2572810.17816/KMJ2020-435Research ArticleRisk factors for rebleeding in patients with peptic ulcer bleedingValeevM Vvmv820@yandex.ruTimerbulatovSh Vvmv820@yandex.ruBashkir State Medical UniversityBeloretsk Central District Hospital1306202010134354401303202013042020Copyright © 2020, Valeev M.V., Timerbulatov S.V.2020<p><strong>Aim.</strong> To analyze the results of treatment of patients with ulcerative bleeding, to identify the main risk factors for rebleeding in patients with peptic ulcer bleeding.</p>
<p><strong>Methods.</strong> A retrospective analysis of the treatment results of 240 patients with acute peptic ulcer bleeding who were hospitalized in the Beloretsk Central District Hospital from 2008 to 2018 was carried out. Patients were divided into two groups: group 1 52 patients with rebleeding, group 2 188 patients in whom rebleeding did not occur.</p>
<p><strong>Results.</strong> Rebleeding in patients with peptic ulcer was observed in 21.7% of cases. The surgical rate was 22.9% and mortality 6.3%. Based on the obtained data, rebleeding should recognize as a risk factor for death [odds ratio (OR) 68.9; 95% confidence interval (CI) 8.8 to 539.7; p 0.001]. Surgical treatment for rebleeding had unsatisfactory results (postoperative mortality in group 1 26.8%, in group 2 0). Risk factors for rebleeding in peptic ulcer bleeding include localization of the ulcer on the lesser curvature of the stomach (OR=2.37; 95% CI=1.18 to 4.74) and the posterior wall of the duodenum (OR=3.84; 95% CI=1.69 to 8.73), as well as Forrest type IIA ulcer (OR=2.67; 95% CI=1.55 to 6.48). Forrest IIc and III ulcers reduce the risk of rebleeding (OR=0.24; 95% CI=0.10 to 0.56). It was found that a shock index, a decreased level of total protein and red blood cells, and an increasing level of urea have a statistically significant relationship with rebleeding in peptic ulcer bleeding.</p>
<p><strong>Conclusion.</strong> Rebleeding in patients with peptic ulcer is a serious complication of the disease that significantly increases mortality, and predicting the risk of rebleeding is one of the possible tools that can improve treatment outcomes and reduce mortality.</p>upper gastrointestinal bleedingthe peptic ulcer bleedingrebleedingгастродуоденальные кровотеченияязвенные кровотечениярецидив кровотечения[Wuerth B.A., Rockey D.C. Changing epidemiology of upper gastrointestinal hemorrhage in the last decade: A nationwide analysis. Dig. Dis. Sci. 2018; 63: 1286–1293. DOI: 10.1007/s10620-017-4882-6.][Jairath V., Martel M., Logan R.F. et al. Why do mortality rates for nonvariceal upper gastrointestinal bleeding differ around the world? A systematic review of cohort studies. Can. J. Gastroenterol. 2012; 26: 537–543. DOI: 10.1155/2012/862905.][Stupin V.A., Baglayenko M.V., Kan V.I. et al. Lethality after gastroduodenal ulcer bleeding. Khirurgiya. Zhurnal im. N.I. Pirogova. 2013; (5): 31–35. (In Russ.)][Botianu A., Matei D., Tantau M. et al. Mortality and need of surgical treatment in acute upper gastrointestinal bleeding: a one year study in a tertiary center with a 24 hours/day 7-days/week endoscopy call. Has anything change? Chirurgia (Bucur). 2013; 108 (3): 312–318. PMID: 23790778.][Holster I.L., Kuipers E.J. Management of acute nonvariceal upper gastrointestinal bleeding: current policies and future perspective. World J. Gastroenterol. 2012; 18 (11): 1202–1207. DOI: 10.3748/wjg.v18.i11.1202.][Lu Y., Barkun A.N., Martel M. Adherence to guidelines: a national audit of the management of acute upper gastrointestinal bleeding. The REASON registry. Can. J. Gastroenterol. Hepatol. 2014; 28 (9): 495–501. DOI: 10.1155/2014/252307.][Hearnshaw S.A., Logan R.F.A., Lowe D. et al. Acute upper gastrointestinal bleeding in UK: patients characteristics, diagnoses and outcomes in the 2007 UK audit. Gut. 2011; 60: 1327–1335. DOI: 10.1136/gut.2010.228437.][Leerdam M.E. Epidemiology of acute upper gastrointestinal bleeding Best Pract. Res. Clin. Gastroenterol. 2008; (22): 209–224. DOI: 10.1016/j.bpg.2007.10.011.][Zdzitovetskiy D.E., Borisov R.N., Kovalenko O.V. Results of treatment of patients with upper gastrointestinal bleeding according to the data of the N.S. Karpovich State Medical University for 3 years. Collection of scientific and practical works. In: Sbornik nauchno-prakticheskikh rabot “Aktual'nye voprosy sovremennoy khirurgii”. 2018; 121–125. (In Russ.)][Ansberg K., Ye W., Lu Y. et al. Hospitalisation of and mortality from bleeding peptic ulcer in Sweden: A nationwide time-trend analysis. Aliment. Pharmacol. Ther. 2011; 33 (5): 578–584. DOI: 10.1111/j.1365-2036.2010.04562.x.][Ljubicic N., Puljiz Z., Budimir I. et al. The influence of etiologic factors on clinical outcome in patients with peptic ulcer bleeding. Dig. Dis. Sci. 2012; 57 (12): 3195–3204. DOI: 10.1007/s10620-012-2273-6.][Garcia-Iglesias P., Villoria A., Suarez D. et al. Meta-analysis: predictors of rebleeding after endoscopic treatment for bleeding peptic ulcer. Aliment. Pharmacol. Ther. 2011; 34 (8): 888–900. DOI: 10.1111/j.1365-2036.2011.04830.x.][Lip H.T., Heah H.T., Huei T.J. et al. Rockall risk score in predicting 30 days non-variceal upper gastrointestinal rebleeding in a Malaysian population. Med. J. Malaysia. 2016; 71: 225–230. DOI: 10.1111/j.1572-0241.2003.07517.x.][Khunafin S.N., Fedorov S.V., Petrov Yu.V. et al. Gastroduodenal ulcerous hemorrhages. Permskiy meditsinskiy zhurnal. 2014; 31 (5): 17–21. (In Russ.) DOI: 10.17816/pmj31517-21.][Jimenez Rosales R., Martinez-Cara J.G., Vadillo-Calles F. et al. Analysis of rebleeding in cases of an upper gastrointestinal bleed in a single center series. Revista Espanola Enferm de Enfermedades Digestivas. 2018; 111: 189–192. DOI: 10.17235/reed.2018.5702/2018.][Shchegolev A.A. Gastrointestinal hemorrhage. National clinical recommendations of the Russian Ministry of health. Meditsinskaya gazeta. 2015; (90): 8. (In Russ.)][Gralnek I.M., Dumonceau J.M., Kuipers E.J. et al. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2015; 47 (10): 1–46. DOI: 10.1055/s-0034-1393172.][Brullet E., Garcia-Iglesias P., Calvet X. et al. Endoscopist’s judgment is as useful as risk scores for predicting outcome in peptic ulcer bleeding: a multicenter study. J. Clin. Med. 2020; 9 (2): 408. DOI: 10.3390/jcm9020408.][Marmo R., Koch M., Cipoletta L. et al. Predicting mortality in non-variceal upper gastrointestinal bleeders: validation of the Italian PNED Score and Prospective Comparison with Rockall Score. Am. J. Gastroenterol. 2010; 105 (6): 1284–1291. DOI: 10.1038/ajg.2009.687.][Blatchford O., Murray W.R., Blatchford M. A risk score to predict need for treatment for upper-gastrointestinal haemorrhage. Lancet. 2000; 356 (9238): 1318–1321. DOI: 10.1016/s0140-6736(00)02816-6.][Saltzman J.R., Tabak Y.P., Hyett B.Y. et al. A simple risk score accurately predicts in-hospital mortality, length of stay, and cost in acute upper GI bleeding. Gastrointest. Endosc. 2011; 74 (6): 1215–1224. DOI: 10.1016/j.gie.2011.06.024.][Rockall T.A., Devlin H.B., Logan R.F.A. et al. Selection of patients for early discharge or outpatient care after acute upper gastrointestinal haemorrhage. National Audit of Acute Upper Gastrointestinal Haemorrhage. Lancet. 1996; 347 (9009): 1138–1140. DOI: 10.1016/s0140-6736(96)90607-8.][Lebedev N.V., Klimov A.E., Barkhudarov T.V. Prognosis for relapse of gastroduodenal ulcer bleeding. Khirurgiya. Zhurnal im. N.I. Pirogova. 2009; (2): 32–34. (In Russ.)]