Predictors of urgent complications of peptic ulcer

Abstract

Introduction. In recent decades, there has been a decrease in the prevalence of peptic ulcer (PU), but this trend does not correlate with the frequency of bleeding and mortality from PU: the disease remains the main cause of bleeding with a high mortality rate. Aim. To study the predictors of urgent complications of PU, using endoscopic, laboratory and clinical signs of gastric bleeding. Materials and methods. Observational cross-sectional (one-stage) study of 181 hospital patients diagnosed with ulcerative disease (84 men, 97 women), mean age 53 ± 27.6 (18–89) years. The stratification of endoscopic characteristics of ulcerative defects of the mucous membrane of the stomach and duodenum (DU) was carried out according to the Clinical guidelines “Diagnosis and treatment of PU in adults (2020)”, bleeding assessment – according to the Forrest classification (1974), selection of patients’ age by periods: 18–35 years (young age); 36–59 years (average age); 60–74 years old (old age); 75–89 years old (old age). Results. The results of studies have shown that the potential for ulcer bleeding is increased in the presence of the following factors. An increase in the patient’s age (the proportion of middle age is 44.2%, the elderly – 35.4%) and male gender. Duration of ulcer history (46.9%), H. pylori-positivity (74.6%); comorbidities requiring anticoagulants, antiplatelet agents and non-steroidal anti-inflammatory drugs (NSAIDs) (70.1%), the presence of two or more risk factors (20.4%). Conclusion. Not only predictors of urgent complications of PU have been established, but also a dissonance indicating a high frequency of occult bleeding in the disease. The frequency of laboratory symptoms of anemia – 55.8%; endoscopic signs – 19.3%, including stigmata of a high risk of rebleeding – 14.3%; clinical symptoms of gastric blood loss – 14.4%. The risk of complications and mortality is associated with both frequent latent course and escalation of NSAID consumption.