Treatment of Acute Gastroduodenal Bleeding in Patients With Severe Burn Injuries

Abstract

OBJECTIVES: Among causes of gastrointestinal bleeding, stress ulcers occupy the second place, second only to chronic ulcers of the stomach and duodenum; gastrointestinal bleeding accounts for 10% to 20% of all causes of hemorrhage. Bleeding relapses from acute stress ulcers (mortality rate range, 60%-90%) are particularly dangerous. Our aim was to compare treatment methods for patients with bleeding from acute gastroduodenal ulcers after severe burns. MATERIALS AND METHODS: Over the past 10 years at our burn department (Samarkand City Medical Association), 80 patients (average age of 51 ± 16 years; 46.4% older than 60 years) with severe burns and bleeding from acute gastroduodenal ulcers were treated. The total area of thermal damage to the skin indicated the significant severity of thermal injury (average of 36.7 ± 7.7% of body surface). Patients were divided into 2 groups: main group (n = 42; 7-day antiulcer therapy) and control group (n = 38; H2-receptor blockers and traditional treatment). RESULTS: In the main group, VEGF concentrations remained virtually unchanged for 3 days compared with that shown in the control group, with a predisposition for gastroduodenal complications but decreased to 18.5% on day 7 and to 24.2% on day 14. In patients without a tendency for gastroduodenal complications, there was a decrease of 10.9% on day 7 and 15.4% on day 14 compared with patients in the control group. Thus, the use of L-arginine-containing drug in the main group of patients on all sampling days resulted in a decrease of VEGF concentration compared with that shown in the control group. CONCLUSIONS: Stable hemostasis during bleeding from acute gastroduodenal ulcers in patients with severe burn injuries was achieved in 77.8% of the control group (who received antisecretory therapy with H2-receptor blockers) and in 88.1% of the main group (antisecretory treatment with addition of dopamine D2-receptor blockers).