Study Of Endoscopy Combined With High Dose Proton Pump Inhibitors In The Treatment Of Patients With Acute Non-variceal Upper Gastrointestinal Bleeding

Background Acute non-variceal upper gastrointestinal bleeding(ANVUGIB)is defined as bleeding from the digestive tract above the flexor ligament(also known as the Treitz ligament)of non-nonvariceal origin,including bleeding from the bile or pancreatic ducts and bleeding at the anastomotic site after gastrojejunostomy,with no esophageal and gastric varices on endoscopy.Most of the bleeding lesions were caused by upper gastrointestinal diseases,amongst which peptic ulcer,upper gastrointestinal tumors,acute gastric mucosal lesions were the most common,and few were caused by biliary and pancreatic diseases.Rare cases include Mallory-Weiss Syndrome,vascular malformation of upper digestive tract,prolapse or intussusception of gastric mucosa,physical,chemical and radiation injury and periampullary tumors.Systemic diseases included liver and kidney dysfunction,infection,connective tissue disease.The characteristic clinical presentation is hematemesis accomanied by melena.Hematochezia may occur depending on the location of the hemorrhagic site,the volume and the speed of blood loss.In the early stages,the clinical presentation includes dizziness and fatigue.An increase in blood loss can precipitate an increase in heart rate,blood pressure decline and other manifestations of peripheral circulatory failure;severe hemorrhagic shock and death can occur if timely treatment is not received.The use of endoscopic hemostasis combined with proton-pump inhibitor treatment is nowadays widely used in the treatment of acute non-variceal upper gastrointestinal bleeding.Objective To comprehensively analyze the clinical efficacy of high-dose proton-pump inhibitor combined with endoscopic therapy in the treatment of acute non-variceal upper gastrointestinal bleeding and investigate risk factors associated with patient prognosis,with a view to providing clinical reference for the treatment of ANVUGIB.Method According to a defined set of inclusion and exclusion criteria,183 patients with acute non-variceal upper gastrointestinal bleeding treated in our hospital from October 2014 to April 2018 were analyzed,retrospectively.The 183 patients were divided into three groups: conventional dose proton pump therapy combined with endoscopic hemostasis group(n ≤ 60),high dose proton pump inhibitor treatment group(n ≤ 58),endoscopic hemostasis combined with high dose proton pump inhibitor treatment group(n ≤ 65).The general demographic data,medical history data and laboratory data of each group were collected,including the time to hemostasis,Forrest grade,rebleeding rate,average blood transfusion volume and hospitalization rates were collected.The therapeutic effect of different treatment methods on acute non-variceal upper gastrointestinal bleeding was compared.In addition,patients treated with endoscopic hemostasis combined with high dose proton pump inhibitors were further divided into two groups according to incidence of rebleeding:effective hemostasis group(n=42)and rebleeding group(n=23).Risk factors for rebleeding after hemostasis in patients with acute nonvariceal upper gastrointestinal bleeding were screened and analyzed using.Result Patients with acute non-variceal upper gastrointestinal bleeding were treated with endoscopic hemostasis combined with high-dose proton-pump inhibitor therapy.The time to hemostasis,average blood transfusion volume,average length of hospital stay,and rebleeding rate after achieving hemostasis,were significantly lower than those in the other two groups,the total effective rate was significantly higher than the other two groups(p< 0.05),the difference was statistically significant.Shock Index greater than 1,rockall score greater than 5,a blatchford score greater than 6 were independent risk factors for rebleeding in patients with acute non-varicose upper gastrointestinal bleeding treated with endoscopic hemostasis combined with high dose proton pump inhibitor for the first time.Conclusion High-dose proton-pump inhibitor combined with endoscopic therapy is an effective treatment for acute non-variceal upper gastrointestinal bleeding,which can significantly reduce the volume of blood loss,shorten hospital stay,and improve the efficacy of treatment.This treatment strategy has high potential clinical application value and developmental prospect.