A Complex, Multidisciplinary Approach to Prevention of Gastro-Duodenal Bleeding in Therapeutic Patients of a General Hospital

The aim of this study was to make the prevention of EU-GDB more efficient in therapeutic patients admitted to a general hospital by using a multidisciplinary approach that includes a diagnostic algorithm, treatment protocol, and individual methods of EU-GDB prevention. Materials and Methods: The study included 114 patients of the therapeutic, pulmonary, and cardiology departments of the Voronezh City Emergency Care Hospital. The patients had been admitted due to destabilization of their underlying conditions and displayed signs of acute gastroduodenal erosions and ulcers during their stay in the hospital. All the patients were randomly divided into two equal groups: the main group and the comparison group. A multidisciplinary approach was applied to patients of the main group (n=58; mean age, 62.64±14.37); it included early pre-clinical diagnosis of EU-GDI by FGDS on the second or third day after their admission to the hospital, which helped to reveal in a timely manner uncomplicated EU-GDI and directly start local treatment as a part of complex therapy. An algorithm of the procedure provides for participation of a surgeon. Powder-like biologically active granular sorbents of the new generation (ASEPTISORB-A, ASEPTISORB-D, or ASEPTISORB-DT) were applied to the revealed acute erosions and gastroduodenal ulcers during the FGDS procedure to prevent hemorrhagic complications. After manifestation of the first signs of EU-GDB: during the curative endoscopy, the use of the developed minimally invasive method of endoscopic hemostasis, which provided combined application of a local haemostatic preparation Gelplastan and ASEPTISORB-D to the defect area. In the comparison group(n=56), the traditional technique of surgical consultations “on demand” was used. FGDS was performed when first symptoms appeared. Common methods of endoscopic hemostasis without local treatment of EU-GDI and application of granulated sorbents were used in this group. Conclusion: The developed program helps to prevent hemorrhagic complications, exclude emergency operations, and reduce mortality rate by 3 times.