Pediatrician (St. Petersburg)Pediatrician (St. Petersburg)2079-78502587-6252Eco-Vector1915510.17816/PED10543-50Research ArticleDiagnosis and treatment of upper gastrointestinal bleeding in patients with acute cerebrovascular accidentKorolevMikhail P.<p>MD, PhD, Dr Med Sci, Professor, Head, Department of General Surgery with a Course of Endoscopy</p>korolevmp@yandex.ruSpesivtsevYuriy A.<p>MD, PhD, Dr Med Sci, Professor, Department of General Surgery with a Course of Endoscopy</p>spesivtsev1952@mail.ruFedotovLeonid E.<p>MD, PhD, Dr Med Sci, Professor, Department of General Surgery with a Course of Endoscopy</p>Fedotov-Le@yandex.ruKlimovAleksey V.<p>MD, PhD, Assistant Professor, Department of General Surgery with a Course of Endoscopy</p>klimorl@mail.ruTerekhovIgor S.<p>Anesthesiologist, Department of Anesthesiology and Resuscitation</p>igor_terekhov@inbox.ruKondratyevAnatoliy N.<p>MD, PhD, Dr Med Sci, Professor, Head, Department of Anesthesiology and Resuscitation</p>Anest-neuro@mail.ruDalievBahodir B.<p>Otorhinolaringologist, ENT Department</p>bahodirdaliev@gmail.comDoniyarovShokhrukh Kh.<p>Postgraduate Student, Department of General Surgery with a Course of Endoscopy</p>shoxrux.daniyarov@gmail.comSt. Petersburg State Pediatric Medical University, Ministry of Healthcare of the Russian FederationRussian Polenov Research Neurosurgical InstituteSM-ClinicSt. Petersburg State Pediatric Medical University, Ministry of Healthcare of the Russian Federation2812201910543502801202028012020Copyright © 2020, Korolev M.P., Spesivtsev Y.A., Fedotov L.E., Klimov A.V., Terekhov I.S., Kondratyev A.N., Daliev B.B., Doniyarov S.K.2020<p>Bleeding from the uppergastrointestinal tract is one of the most dangerous complications in patients with acute CVA (ischemic and/or hemorrhagic type). The combination of these conditions requires special attention in the diagnosis and choice of treatment methods. Central Nervous System pathology makes diagnosis, choosing methods oftreatment and the use of drug more complicated to surgeons in the postoperative period. With onset of hemorrhage, antithrombotic treatment should be canceled, that can negatively affect the results of treatment of patients with ischemic type of cerebral vascular accident. The use of anti-ulcer drugs, namely proton pump inhibitors, may increase the risk of hospital-acquired pneumonia,<em>Clostridium difficile</em>infections, and cardiovascular diseases. These factors force us to consider issues related to diagnosis and treatment plans in this group of patients. The most promising direction in the treatment of patients with ischemic or hemorrhagic stroke in combination with gastroduodenal bleeding is the identification of risk factors for upper gastrointestinal bleeding, early endoscopic diagnosis and treatment, performing preventive treatment. The article presents a brief review of domestic and foreign literature, some issues of etiology and pathogenesis of gastroduodenal bleeding in patients with cancer, the results of our own research, capabilities of modern endoscopy in the diagnosis and treatment of gastrointestinal bleeding in this group of patients. The algorithm of management of patients with a combination of bleeding from the upper gastrointestinal tract and CNS pathologies.</p>gastroduodenal bleedingstrokeendoscopyendoscopic hemostasisгастродуоденальные кровотеченияинсультэндоскопияэндоскопический гемостаз[Camara-Lemarroy CR, Ibarra-Yruegas BE, Gongora-Rivera F. Gastrointestinal complications after ischemic stroke. J Neurol Sci. 2014;346(1-2):20-25. https://doi.org/10.1016/j.jns.2014.08.027.][Charlson ME, Pompei P, Ales KL, McKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chron Dis. 1987;40(5):373-383. https://doi.org/10.1016/0021-9681(87)90171-8.][Davenport RJ, Dennis MS, Wellwood I, Warlow CP. Complications after acute stroke. Stroke. 1996;27(3): 415-420. https://doi.org/10.1161/01.str.27.3.415.][Davenport RJ, Dennis MS, Warlow CP. Gastrointestinal hemorrhage after acute stroke. Stroke. 1996;27(3): 421-424. https://doi.org/10.1161/01.str.27.3.421.][Eikelboom JW, Mehta SR, Anand SS, et al. Adverse impact of bleeding on prognosis in patients with acute coronary syndromes. Circulation. 2006;114(8):774-782. https://doi.org/10.1161/CIRCULATIONAHA.106.612812.][Fujisawa T, Kumagai T, Akamatsu T, et al. Changes in seroepidemiological pattern of helicobacter pylori and hepatitis a virus over the last 20 years in Japan. Am J Gastroenterol. 1999;94(8):2094-2099. https://doi.org/10.1016/S0002-9270(99)00339-1.][Forrest JA, Finlayson ND, Shearman DJ. Endoscopy in gastrointestinal bleeding. Lancet. 1974;2(7877): 394-397. https://doi.org/10.1016/s0140-6736(74) 91770-x.][Gralnek IM, Dumonceau JM, Kuipers EJ, et al. Diagnosis and management of nonvariceal upper gastrointestinal hemorrhage: European Society of Gastrointestinal Endoscopy (ESGE) Guideline. Endoscopy. 2015;47(10): a1-46. https://doi.org/10.1055/s-0034-1393172.][Groenen MJ, Kuipers EJ, Hansen BE, Ouwendijk RJ. Incidence of duodenal ulcers and gastric ulcers in a western population: back to where it started. Can J Gastroenterol. 2009;23(9):604-608. https://doi.org/10.1155/2009/181059.][Hsu HL, Lin YH, Huang YC, et al. Gastrointestinal hemorrhage after acute ischemic stroke and its risk factors in Asians. Eur Neurol. 2009;62(4):212-218. https://doi.org/10.1159/000229018.][Kothari RU, Brott T, Broderick JP, et al. The ABCs of measuring intracerebral hemorrhage volumes. Stroke. 1996;27(8):1304-1305. https://doi.org/10.1161/01.str.27.8.1304.][Lai KC, Lam SK, Chu KM, et al. Lansoprazole for the prevention of recurrences of ulcer complications from long-term low-dose aspirin use. N Engl J Med. 2002;346(26):2033-2038. https://doi.org/10.1056/NEJMoa012877.][Lin KJ, Hernandez-Diaz S, Garcia Rodriguez LA. Acid suppressants reduce risk of gastrointestinal bleeding in patients on antithrombotic or anti-inflammatory therapy. Gastroenterology. 2011;141(1):71-79. https:/doi.org/10.1053/j.gastro.2011.03.049.][Misra UK, Kalita J, Pandey S, Mandal SK. Predictors of gastrointestinal bleeding in acute intracerebral haemorrhage. J Neurol Sci. 2003;208(1-2):25-29. https://doi.org/10.1016/s0022-510x(02)00415-x.][O’Donnell MJ, Kapral MK, Fang J, et al. Gastrointestinal bleeding after acute ischemic stroke. Neurology. 2008;71(9):650-655. https://doi.org/10.1212/01.wnl.0000319689.48946.25.][Ogata T, Kamouchi M, Matsuo R, et al. Fukuoka Stroke Registry. Gastrointestinal bleeding in acute ischemic stroke: recent trends from the fukuoka strokeregistry. Cerebrovasc Dis Extra. 2014;4(2):156-164. https://doi.org/10.1159/000365245.][Roosendaal R, Kuipers EJ, Buitenwerf J, et al. Helicobacter pylori and the birth cohort effect: evidence of a continuous decrease of infection rates in childhood. Am J Gastroenterol. 1997;92(9):1480-1482.][Schirmer CM, Kornbluth J, Heilman CB, Bhardwaj A. Gastrointestinal prophylaxis in neurocritical care. Neurocrit Care. 2012;16(1):184-193. https://doi.org/10.1007/s12028-011-9580-1.][Wijdicks EF, Fulgham JR, Batts KP. Gastrointestinal bleeding in stroke. Stroke. 1994;25(11):2146-2148. https://doi.org/10.1161/01.str.25.11.2146.]