During the second step of our research we took advantage of our structured oetiologies in order to compare their prevalence in our group with the prevalence described by previous studies (Merck Manual, 17
edition). The results can be seen in chart 3.
As can be seen, there is an increase of gastric ulcer and oesophagitis in our group as well as a decrease of duodenal ulcer. This helps us to characterize our group of patients properly, but also raises one question: what is the cause for this change in the occurence of the various pathologies? At this point, we believe it might be connected with nutrition habits, but as we do not have any proof to support this we expect further studies to consider it.
The third step of our study was aimed at a correct classification of the therapeutic methods. Although we mentioned pharmaceutical treatment distinct from endoscopic treatment, this does not mean that patients who underwent endoscopic therapy were not given medication. As has been stated in previous studies, pluritherapy is usually considered more efficient than single therapy, and therefore physiopathological treatment was considered useful for all types of patients. The patients mentioned as having therapeutic treatment did not need any other kind of intervention than medicines.
Chart 4. The elected therapeutic methods.
|Classic surgery||Medicine||Endoscopic haemostasis||Endoscopic surgical procedures||Other endoscopic methods|
|12 patients||60 patients||22 patients||13 patients||18 patients|
We also consider important the fact that out of the 8 patients referred to Coltea University Hospital with Forrest I A bleeding, 5 were helped by endoscopic means (usually pluritherapy – electrocoagulation + local adrenaline injection), the other 3 being redirected to surgery because of recurrent bleeding following the endoscopic procedure. Patients redirected to classic surgery were suffering from gastric tumours. Out of the 8 patients referring to the hospital with varices, either oesophageal or of the fornix, only 2 came to the emergency room with Forrest IB bleedings, and both of these were treated by endoscopic clipping.
On the basis of the medical records, we calculated the number of cases that would previously have been directed to classic surgery. We compared this expected percentage with the actual percentage of surgery, obtaining a significance for the decrease in the role of surgery which was very high (p = 0.0002). The significance for the increase in the role of endoscopy following its recent uses was reasonably high (p = 0.05). We also compared the number of cases that were solved by classic surgery with the number of cases solved by endoscopic methods. We obtained a p-value = 0 (highly relevant, in favour of endoscopy). This was interpreted as a measure of the usefulness of endoscopy in the general population suffering from UGIH. This, considered with previous results, is actually what gave us the final proof that endoscopy can be the solution for an impressive number of patients.
We then proceeded to the fourth level of our study, considering the impact of endoscopy on aetiologic groups. However, the calculation for the general group showed a higher impact of endoscopy than that on the aetiologic group. This can be explained by the small number of patients in each aetiologic group, this has statistically produced larger confidence intervals for each calculus. A study that would focus on only one aetiologic group could estimate the real importance of the impact. However, our results showed that bleeding gastric ulcer was offered a better treatment with the help of endoscopy: the role of endoscopy increased significantly (p = 0.05), while the role of classic surgery showed an important decrease (p = 0.02). The therapies for oesophagitis and duodenal ulcer have changed slightly and, as expected, the therapy for gastric cancer suffered no change.
The conclusions follow the steps of the study. It is important for therapy and epidemiology to know that the debut of UGIH is significantly earlier in males than in females, which means that the practitioner has to cure a younger male patient who is more capable of fighting with the disease but, at the same time, the elected treatment must permit a longer life after healing. Also 3 times more men than women refer at the hospital for gastric ulcer and 2.5 times more men refer for oesophagitis. In our country gastric pathology seems to occur more often than intestinal pathology, and the risk factors that or lead to this situation should be examined. With this clinical basis, the practitioner may have a wider view on the choice of therapy. The use of endoscopy as a therapeutic mean proves its efficiency on various pathologies at any age, in emergency as well as regular conditions, and decreases the risks undergone by the patient. It is a reliable alternative to classic surgery, and the introduction of endoscopic therapy significantly changed the approach to ulcerative lesions. It has shown good chances to change the outcome of UGIH produced by many other conditions. It is important to state once again that endoscopy is a very modern, efficient and easy to use method for treating UGIH, and these qualities remain fundamental reasons for its massive impact on medical practice.
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