Use of non-steroid anti-inflammatory preparations for prevention of acute pancreatitis after endoscopic retrograde cholangiopancreatography (literature review)

Non-steroid anti-inflammatory preparations (NSAlDs) - a unique class of the medical products possessing analgesic, anti-inflammatory and febrifugal effect. NSAlDs are widely used in various branches of medicine, especially at a pathology of the oporno-impellent device for knocking over of a pain after traumas, and also for symptomatic therapy of acute and chronic rheumatic diseases. Endoscopic retrograde cholangiopancreatography (ERCP) is one of the most important methods for diagnosis of diseases of the pancreatobiliary zone. ln addition to visualizing intraductal changes, this technique allows a wide range of surgical procedures, such as papillosfinkterotomiya, removal of stones, stenting and more. Unfortunately, during ERCP, serious complications may arise, primarily acute pancreatitis. To prevent the development of this pathology are offered a variety of technical and pharmacological approaches, but not all of them have proven effective in clinical trials. One of the most successful means for the prevention of post-ERCP acute pancreatitis was the use of nonsteroidal anti-inflammatory drugs. Appointment NSAlDs at carrying out ERCP - in an hour to - or is direct after procedure, essentially improves its shipping. First of all it is a question of reduction of number and reduction of weight of ERCP - associated acute pancreatitis potentially menacing to life of complication. Though in clinical researches it has not been shown authentic decrease mortality from the given pathology, nevertheless, it is necessary to think that active preventive maintenance will allow to rescue patients from the destruction caused heavy iatrogenic by a pancreatitis. This review is devoted to an analysis of published data on the subject

Comparison of the Endoscopic Picture in Case of Complications of the upper Gastrointestinal Tract Caused by the Use of Antithrombotic Agents and Non-Steroidal Anti-Inflammatory Drugs

Intaking antithrombotic funds (ATA) and non-steroidal anti-inflammatory drugs (NSAIDs) is one of the most frequent causes of pathology in gastrointestinal (GI) tract.The purpose of the study: comparison of pathological changes of the mucous membrane in the upper GI tract, that occur against the background of ATA and NSAIDs admission.Material and methods. Endoscopic data of two groups of patients taking ATA and NSAIDS have been compared. The first group of 448 patients from the 10th Gastrointestinal Department in N.N. Burdenko Main Military Clinical Hospital was on record from 2013 to 2017. The patients had erosive ulcerous changes of gastrointestinal mucosa, occurred against the background of the ATA admission. The second group comprised 6431 patients with rheumatic diseases. They were hospitalized in the clinic of V.A. Nasonova Research Institute of Rheumatology in the period from 2007 to 2016 and took NSAIDs regularly.Results. Duodenal and gastric ulcer changes in gastric mucosa and duodenal ulcers were identified in 168 (37.5 %) patients taking ATA and in 1691 (26.3 %) patient treated with NSAIDS. Structure of pathology varied. So, against the background of ATA and NSAIDS admission, the number of acute gastric ulceration amounted to 6.5 % and 15.5 % (p < 0.001); acute ulcers duodenal was 2.9 % and 4.9 %; combined ulcerative lesions of gastric and duodenal was 2.9 % and 2.0 %; multiple erosions of gastroduodenal mucosa were 52.4 % and 15.7 % (p < 0.001); single erosion was 35. 1% and 61.6 %. The factor of ulcer history and age ≥ 65 years old increased significantly the risk of duodenal and gastric ulcer changes in patients taking ATA and NSAIDs: OR 5.182 (95% CI 2.701–9.942) and 3.24 (95% CI 2.19–5.34), 4.537 (95% CI 2.036–10.11) and 2.016 (95% CI 1.230–2.917) respectively. Intaking of proton pump inhibitor (PPI) reduced significantly the risk of complications for both ATA and NSAIDs: OR 0.329 (95% CI 0.199–0.546) and 0.317 (95% CI 0.210–0.428) respectively.Conclusion. The structure of pathology of mucous in the upper gastrointestinal tract that arose against the backdrop of ATA and NSAIDs admission is different. The first is characterized by a multiple erosion, while the second one has single acute distal gastric ulcers. The ulcerative history and advanced age of patients increase significantly the risk of complications concerning the gastroduodenal mucosa when using ATA and NSAIDs. PPI is the effective means of preventing this pathology

ENDOBILIARY INTERVENTIONS AT ACUTE NECROTIC PANCREATITIS

The study included patients with acute necrotic pancreatitis and confirmed biliary hypertension. The endoscopic retrograde cholangiopancreatography (ERSP) and endoscopic papillosphincterotomy (EPST) supplemented with lithoextrac- tion were conducted immediately. We concluded that in cases when intraduct pathology causes biliary hypertension and initial severity of patient's condition doesn't exceed 11 physiological status severity (PSS) scale conducting ERSP with EPST and lithoextraction is more preferable than drainage of gall bladder

Gastro-Intestinal Tract Complications During Antithrombotic Therapy

Use of antithrombotic aids (ATA)  significantly  impact  the prevention of life-threatening cardiovascular complications. ATA applications, however, are associated with a wide range of adverse digestive system responses. Due to, continuously growing clinical use of ATA this problem has become a current challenge of contemporary medicine.Purpose of the study was to evaluate the patterns of digestive system damage in patients receiving ATA.Materials and Methods. 672 patients were examined, 91.0% males, 46.7±17.4 years of age, who had digestive system changes that  occurred  due to ATA intake. 71 patients were admitted for treatment after gastrointestinal (GI) bleeding; other  patients were hospitalized  because of disorders  of the digestive  system or erosive and ulcerous changes of the digestive  system detected by endoscopy.  The following parameters were  evaluated:  GI bleeding sources, character of complaints,  the endoscopic patterns due to intake of different ATAs (low doses of aspirin, warfarin, clopidogrel,  dabigatran, rivaroxaban, low-molecular  heparin,  combined  therapy), and of risk factors for GI complications.Results. The sources of GI bleeding (n=71) included  gastric ulcers and/or erosions (39.4%), duodenum ulcers and/or erosions (21.1%), colon ulcers and/or erosions (28.2%), unknown  (11.3%). The majority of 672 patients noticed  various  complaints:  sensation  of heaviness  in epigastrium (62.8%),  gastralgia  (46.7%),  burning  sensation (34.3%). Endoscopy found erosive esophagitis (13.2%), ulcers in stomach and/or duodenum (11.6%), multiple (  10) erosions of stomach or duodenum (17.1%), sporadic erosions of stomach or duodenum (24.4%). In 32.3% cases no erosive or ulcerous alterations were found. H. pylori was identified in 57.9% of patients. There was no significant difference in character of alterations in the upper digestive system between patients who received different ATA treatment, except of frequent erosive esophagitis in those patients who received dabigatran (16.8%). The elderly age (  65 years), ulcer history, concomitant intake of NSAIDS, H. pylori presence, and smoking habit were associated with a higher occurrence of pathological alterations of digestive system. Presence  of gastralgia  did not correlate with the development of erosive and ulcerous alterations.Conclusion. In majority of patients who received ATA, the commonly observed erosive and ulcerous alterations in the digestive system might become a source of bleeding