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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