The Study On The Correlation Between Endoscopic Characteristic And Hemorrhage In Patients With Peptic Ulcer

Objective: Peptic ulcer bleeding is one of the common clinical emergency which have higher prevalence all of the word,and can lead to more serious complications such as heart failure,cerebral infarction.Endoscopy is the primary method of diagnosis of peptic ulcer bleeding,due to the rapidly development of digestive endoscopy in the past 20 years.A comprehensive classification of endoscopic features can more accurately determine the severity of patients,guide treatment and evaluate the prognosis.Endoscopic descriptions of peptic ulcer bleeding are mostly based on the Forrest classification at domestic and abroad.Some Forrest classification ? patients with ulcerous base clean,but there was erosion around the ulcer,leading to bleeding,which led to poor prognosis.Forrest classification did not reference the severity of mucosal erosion around the ulcer which may impact on bleeding.This study analyzed the ulcerative and erosive bleeding and its association with different levels of risk by analyzing the severity of ulceration and mucosal erosion around it,which will help to assess hemorrhage and prognosis.Methods: To statistics the upper gastrointestinal bleeding patients who diagnosed as peptic ulcer by endoscopy from July 2015 to December 2015 in the hospital of Dalian university,and grouped them according to the following classification method: 1.Ulcer diameter:(1)?1cm,(2)1cm<and?2cm,(3)> 2cm;2.Forrest classification: ?a,?b,?a,?b,?c,?.3.Peripheral erosive perimeter: A.involving the ulcer all circumference,B.less than the ulcer all circumference and more than 1/2 circumference,C.less than or equal to 1/2 ulcer circumference;4.Severity of erosive surface: A.red surface,B.black surface,C.surface clean.The length of stay,gender,age,bleeding volume,heart rate,blood pressure,blood urea nitrogen,hemoglobin,companion disease,Rockall score and Blatchford score were collected as the observation indicators.Analyze the clinical features and occurrence regularity of peptic ulcer patients,analyzes variability of the endoscopic characteristics that may influence the observation index.Finally,analyze the risk factors which related to hemorrhage by multi-factor logistic regression analysis.Results:There were 225 gastric ulcers and 132 duodenal ulcers in 357 patients.Data showed that men accounted for 85.15%,significantly higher than women(14.85%).Endoscopy showed ulcer with erosion cases accounted for 84.9% and 92.4% of gastric ulcer and duodenal ulcer,respectively.Erosion involving less than 1/2 of the ulcer circumference accounted for 56%.Erosive surface fresh red accounted for 38.7%,suggesting that the recent bleeding.The majority of patients' bleeding volume was 500-1000ml(67.1%),patients with moderate anemia accounted for 46.5%,the average hemoglobin content of 84.96 ± 26.49 g / L.Endoscopic classification of ulcers mostly meet the Forrest ?(56.6%).The Forrest grading patients had significant differences in the amount of hemoglobin,anemia,blood transfusion and risk classification(P <0.05).There were significant differences in the amount of blood transfusions and days of hospitalization between different sizes of ulcers(P <0.01).Peripheral lesions of different degrees of erosion and erosive surface severity and hemoglobin levels were statistically different(P = 0.024).In patients with Forrest ?c and ?,there was a statistically significant difference(P = 0.001)between the amount of hemoglobin and the severity of erosion surrounding the ulcer.There were statistical differences in the moderate anemia with different Forrest classification,erosive circumference and severity of erosive surface.The study found that Forrest ?a patients with moderate anemia is about 2.6 times the risk of patients with grade ?,erosive surface of red and black patients with moderate anemia is 3 times the risk of non-erosion patients by multi-factor logistic regression analysis.Only the severity of erosive surface was significantly associated with moderate anemia,in patients with Forrest ?c and ?.In such patients,the risk of moderate anemia in patients with erosion of red and black surfaces is 3-4 times higher in those with no erosion.In addition,the results showed statistical differences(P <0.05),with severity of erosion on Blatchford score system and days of hospitalization.Conclusion: The extent of anemia was only affected by the severity of erosive surface,and Blatchford classification and length of stay were also affected by severity of erosive surface,in patients with Forrest ?c and ?.Conclusively,the degree of erosion around the ulcer related hemorrhage,in addition,erosive severity around the ulcer,should be the supplementary content of Forrest classification.