The course of gastroduodenal bleedings in peptic ulcer patients with comorbid diabetes mellitus
Background. The prevalence of gastroduodenal ulcerative bleeding reaches 170 cases per 100,000 of the adult population, and the annual mortality due to them is 15 %. Comorbid diabetes mellitus (DM) is an independent risk factor for ulcerative bleeding, and it impairs the effectiveness of therapeutic measures. Seropositivity of patients with DM as carriers of Helicobacter infection is 50–60 % which is registered 90 % more often than in the general population. The purpose was to analyze the nature of gastroduodenal bleeding on the background of comorbid DM, to identify the prognostic criteria. Materials and methods. The study included 1261 patients with gastroduodenal bleedings. The average age of the examined patients was 50 years, the duration of the disease manifestations — 6 years, the duration of bleeding — 47 hours, the severity index — 6 r.u, the severity of bleeding — 2 points, the blood glucose index — 10 mmol/l, glycated hemoglobin (HbA1c) — 8 %, insulin — 25 µIU/ml, the insulin resistance index (HOMA) was 12 r.u. Results. DM in the ratio of mild, moderate and severe 1 : 2 : 1 was present in 17 % of patients with gastroduodenal ulcers, and it was a risk factor for severe bleeding. Comorbid DM determined a more severe ulcerative gastroduodenal bleeding, a greater frequency of its spurting nature, wall blood leakage from ulcers and the development of hemorrhagic shock before treatment, it was a risk factor for bleeding recurrences and significantly worsened the survival of patients, influenced the cardiovascular hemodynamic parameters (the levels of average blood pressure, peripheral vascular resistance, circulating blood volume), and predictive criteria include baseline levels of glycemia, HbA1c and HOMA. Conclusions. Comorbid DM significantly worsens the course of gastroduodenal bleedings, and it is a risk factor for their recurrence.
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Komar OM, Kizlova NM, Trylevych OD, Kravchenko VV. Risk factors for adverse course of gastric and duodenal peptic ulcer. Wiad Lek. 2018;71(1 pt 2):160-164. doi: 10.1177/2050640618764161. (in Russian).
Park S, Park SY, Kim YJ, Hong SM, Chon S, Oh S et al. Effects of rebamipide on gastrointestinal symptoms in patients with type 2 diabetes mellitus. Diabetes Metab J. 2016 Jun;40(3):240-7. doi: 10.4093/dmj.2016.40.3.240.
Chen YC, Ho CC, Yi CH, Liu XZ, Cheng TT, Lam CF. Exendin-4, a glucagon-like peptide-1 analogue accelerates healing of chronic gastric ulcer in diabetic rats. PLoS One. 2017 Nov 2;12(11):e0187434. doi: 10.1371/journal.pone.0187434.
Chi TY, Zhu HM, Zhang M. Risk factors associated with nonsteroidal anti-inflammatory drugs (NSAIDs)-induced gastrointestinal bleeding resulting on people over 60 years old in Beijing. Medicine (Baltimore). 2018 May;97(18):e0665. doi: 10.1097/MD.0000000000010665.
Yu H, Dai XJ, Zhang HB, Huang YT, Ran DZ, Yang Y et al. Efficacy of two bariatric surgeries in type 2 diabetic patients with a body mass index of 25-27.5. Nan Fang Yi Ke Da Xue Xue Bao. 2017 May 20;37(5):693-697.
Peng YL, Leu HB, Luo JC, et al. Diabetes is an independent risk factor for peptic ulcer bleeding: a nationwide population-based cohort study. J Gastroenterol Hepatol. 2013 Aug;28(8):1295-9. doi: 10.1111/jgh.12190.
Wu SC, Chen WT, Fang CW, Muo CH, Sung FC, Hsu CY. Association of vagus nerve severance and decreased risk of subsequent type 2 diabetes in pepticulcer patients: An Asian population cohort study. Medicine (Baltimore). 2016 Dec;95(49):e5489. doi: 10.1097/MD.0000000000005489.
Wei F, Lin X. Diabetes increases morbidity and mortality rates in peptic ulcer bleeding: An updated systematic review and meta-analysis. Turk J Gastroenterol. 2016 Jul;27(4):304-11. doi: 10.5152/tjg.2016.15448.
Elwakil R, Reda MA, Abdelhakam SM, Ghoraba DM, Ibrahim WA. Causes and outcome of upper gastrointestinal bleeding in emergency endoscopy unit of Ain Shams University Hospital. J Egypt Soc Parasitol. 2011 Aug;41(2):455-67.
Murata A, Matsuda S, Kuwabara K, Ichimiya Y, Fujino Y, Kubo T. The influence of diabetes mellitus on short-term outcomes of patients with bleeding pepticulcers. Yonsei Med J. 2012 Jul 1;53(4):701-7. doi: 10.3349/ymj.2012.53.4.701.
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