The peptic ulcer bleeding. Rebleeding prediction and the choice of treatment tactics

Aims. To develop methods for predicting the rebleeding of peptic ulcer, to develop an algorithm for choosing therapeutic tactics based on predicting rebleeding. Methods. 2 retrospective case-control studies were conducted. The first study included 240 patients with peptic ulcer bleeding, which were divided into 2 groups: group 1 - 52 patients with rebleeding; group 2 - 188 patients without rebleeding. The second study included 108 patients with peptic ulcer bleeding who underwent endoscopic hemostasis. Patients are divided into 3 groups depending on the location of the ulcer and the difficulty of performing endoscopic hemostasis Results. According to the results of the first study, it was possible to identify the following clinical, laboratory and endoscopic criteria associated with the onset of rebleeding - shock index, localization of ulcers by lesser curvature of the stomach and the posterior wall of the duodenum, endotypes 2A, 2C and 3 according to Forrest, the level of red blood cells, urea and general blood protein. The developed scale demonstrates a better prognosis of rebleeding than the Glasgow-Blatchford score and Rockall score (AUROC for the new scale is 0.88 with 95% CI: 0.836-0.924, for mGBS - 0.764 with 95% CI: 0.692-0.837, for RS - 0.759 with 95% CI: 0.688-0.830). The second study found that “difficult” localization of an ulcer (subcardial stomach, duodenal bulb) increases the risk of rebleeding after endoscopic hemostasis (OR = 25.4, 95% CI = 2.6 - 244.3). Conclusion. Peptic ulcer bleeding remains an urgent problem today. One of the reasons for unsatisfactory treatment results is a rebleeding. Stratification of the risk of rebleeding should be an important component in the complex of diagnosis and treatment of such patients, influencing the choice of therapeutic tactics.