Medical Chemistry and Its Influence on the Results of Treatment of Patients with Acute Bleeding from the Lower Compartments of the Gastrointestinal Tract

Abstract

Emergency care for patients with gastrointestinal bleeding, despite the substantial progress in drug therapy and development of endoscopic and angiographic methods of hemostasis, remains a very important issue of modern medicine. Acute bleeding from the large intestine causes up to 12-15% of all gastrointestinal bleeding. In the general population it occurs in 0.03% of individuals. There is fibrinolysis inhibitor that had been widely used for last decade. It is Tranexamic acid. Administration of Tranexamic acid is included in national guidelines and a number of international clinical protocols that describes providing medical care to patients with bleeding. To assess efficiency of treatment strategy, that includes administration of Tranexamic acid in patients with bleeding from large intestine. Primary outcomes are number of rebleeding and surgeon interventions. There were 546 inpatients, that underwent treatment in proctology department of 6th Dnipro City Hospital from 2016 to 2023. Patients were between the ages of 35-89. The number of patients under the age of 44 was 34 (6%), 45-59 – 92 patients (17%), 60-74 – 224 patients (41%), over 75 – 196 patients (36%). Gender ratio is 234 males (42,8%) and 312 females (57,2%). After examination of patients, following diseases were determined as causes of bleeding from large intestine: Crohn’s disease – 5,3 %; ulcerative colitis – 12,7 %; colonic diverticulitis – 36,5 %; colorectal cancer – 20,1 %; colonic polips - 1,3 %; hemorrhoids – 24,1%. Strategy including Tranexamic acid permitted to decrease amount of rebleeding and surgical interventions, performed due to failed hemostasis, from 25,6% to 12,9%. Total mortality decreased from 11,5% to 6,4%. Indications for surgical interventions in case of bleeding from the large intestine are failed medication and endoscopic hemostasis, as well as rebleeding. Rebleeding occurs more often in those who is suffered from diverticular disease of the sigmoid colon and colonic villous adenomas.