American Journal of Medicine and Medical Sciences

p-ISSN: 2165-901X    e-ISSN: 2165-9036

2025;  15(10): 3389-3393

doi:10.5923/j.ajmms.20251510.23

Received: Sep. 7, 2025; Accepted: Sep. 28, 2025; Published: Oct. 15, 2025

 

Endoscopic Approach to the Diagnosis and Treatment of Erosive-Ulcerative Infections in the Gastrointestines in Burns

Khaitov Laziz Millionerovich1, Khakimov Erkin Abdikhalilovich1, 2, Mamatov Farrukh Shavkatovich3, Khotamov Ikhtiyor Eshmurotovich4, Davlatov Salim Sulaymonovich5

1Samarkand State Medical University, Samarkand, Uzbekistan

2Samarkand Branch of Republican Scientific Emergency Center

3Head of the Endoscopy Department, Zarmed Pratiksha

4Faculty of General Medicine, Navoi State University

5Bukhara State Medical Institute named after Abu Ali ibn Sino

Correspondence to: Khaitov Laziz Millionerovich, Samarkand State Medical University, Samarkand, Uzbekistan.

Email:

Copyright © 2025 The Author(s). Published by Scientific & Academic Publishing.

This work is licensed under the Creative Commons Attribution International License (CC BY).
http://creativecommons.org/licenses/by/4.0/

Abstract

Relevance. According to the latest data from the World Health Organization (WHO), 11-12 million people suffer from burns annually. About half of them, about 6-7 million, require inpatient treatment, more than 200 thousand victims die due to severe complications and consequences of burns. Objective of the study: Assessment of the effectiveness of endoscopic examination and treatment in the early diagnosis, treatment, and prevention of complications of diseases (erosions, ulcers, bleeding, and perforations) with functional and organic changes in the mucous membrane of the gastrointestinal tract with severe burns. Materials and methods. The study included 105 patients with erosions, ulcers, and bleeding complications of the stomach and duodenum, who were treated in the Combustology department of the Samarkand branch of Republican scientific emergency center in the period from 2022 to 2024. Of these, 82.8% were men and 17.2% were women. Research results. Out of 105 patients, 64 patients underwent EGDS once, 20 patients underwent EGDS twice, and 21 patients underwent EGDS 3-5 times. Conclusions and results of single and multiple EGDS. Gastric erosions in 6% patients, duodenal erosions in 8.5% patients, uncomplicated acute and chronic gastric ulcers in 14% patients, duodenal ulcers in 22.1% patients, combined ulcers in 10.4% patients, Complicated bleeding ulcers FIa - 2% patients, Fib - 3.8% patients, FIIa- 4.7% patients, FIIb - 3.8% patients, FIIc - 5.7% patients, FIII - 17.1% patients with the above-mentioned ulcers but without complications, wound perforation in 1.9% patients. Conclusion. Timely use of endoscopic examination and treatment of patients with severe burns led to a decrease in the lowest mortality rate associated with pathologies in the gastrointestinal tract and their severe complications from 38% to 19.2%. The time taken to eliminate complications associated with the gastrointestinal tract was reduced from 3 to 1.5 days in the early period and from 7 to 5 days in the late period.

Keywords: Severe burns, Gastrointestinal tract, EGDS, Erosion, Ulcers, Bleeding, Perforation

Cite this paper: Khaitov Laziz Millionerovich, Khakimov Erkin Abdikhalilovich, Mamatov Farrukh Shavkatovich, Khotamov Ikhtiyor Eshmurotovich, Davlatov Salim Sulaymonovich, Endoscopic Approach to the Diagnosis and Treatment of Erosive-Ulcerative Infections in the Gastrointestines in Burns, American Journal of Medicine and Medical Sciences, Vol. 15 No. 10, 2025, pp. 3389-3393. doi: 10.5923/j.ajmms.20251510.23.

Article Outline

1. Relevance
2. Materials and Methods
3. Research Results
4. Discussion of Results
5. Conclusions

1. Relevance

According to the latest data from the World Health Organization (WHO), 11-12 million people suffer from burns annually [1,2,3,4]. About half of them, about 6-7 million, require inpatient treatment, more than 200 thousand victims die due to severe complications and consequences of burns [5,6,7]. In Uzbekistan, approximately 12-15 thousand people suffer from burn disease annually [8]. Changes in the gastrointestinal tract in burn disease are directly related to the stage and severity of the disease, and in 3rd-4th degree burns, gastrointestinal dysfunction (perforation, bleeding and septic complications) increases the occurrence, and the combination of these changes worsens the course of the disease, increasing the risk of complications and mortality to 15-25% [9,10,11,12]. Acute lesions and dysfunctional changes in the gastrointestinal tract are detected in 0.2-1.8% of total losses, but in the group of severe burns, these indicators increase by 2.5-3 times. According to endoscopic examination results, acute erosions and ulcers of the gastrointestinal tract in patients with extensive and deep burns are detected in 25-80% of cases, of which 20-25% are complicated by bleeding [13,14,15].
Objective of the study: Assessment of the effectiveness of endoscopic examination and treatment in the early diagnosis, treatment, and prevention of complications of diseases (erosions, ulcers, bleeding, and perforations) with functional and organic changes in the mucous membrane of the gastrointestinal tract with severe burns.

2. Materials and Methods

The study included 105 patients with erosions, ulcers, and bleeding complications of the stomach and duodenum, who were treated in the Combustology department of the Samarkand branch of Republican scientific emergency center in the period from 2022 to 2024. Of these, 87 (82.8%) were men and 18 (17.2%) were women. The age of the patients ranged from 18 to 75 years, the average age was 45 years. Depending on the width and depth of the burn site, it was divided into two groups. In the first group, 72 (68.5%) victims with a frequency of 15-25%, in the second group - 33 (31.4%) victims with a frequency of 30-50%.
For endoscopic diagnosis of the gastrointestinal tract and individual assessment of the intensity of bleeding, the classification proposed by J.A. Forrest in 1974 was used (Fig. 1).
Ia - pulsating arterial hemorrhage
Ib - bleeding seeping under a blood clot
IIa - visible blood vessel at the bottom of the wound
IIb - blood clot firmly attached to the wound bottom
IIc - flat hematin at the base of the ulcer
III - absence of signs of bleeding
Figure 1. Forrest classification endoscopic picture of bleeding intensity
All patients with suspected gastroduodenal bleeding, along with intensive therapy and conservative ulcer treatment after hospitalization, underwent the first diagnostic and therapeutic EGDS in the first 3-6 hours, as well as EGDS examination for dynamic observation and in the presence of signs of recurrence on days 2-5-7-10-14. This process was performed using the standard method under local anesthesia with a 10% lidocaine solution, intravenous anesthesia, or general anesthesia through an endotracheal tube. Based on the EGDS conclusion, our patients received intravenous and intramuscular hemostatic therapy (Sol. Ethamsylate (Dicynoni) 12.5%, Sol. Aminocapronic Acid 5%, Sol. Vikasol 1% solutions were used individually. According to the recommendations of the European Association of Gastroenterologists Maastricht, a first-line scheme was used for the eradication of Helicobacter pylori and conservative treatment (quadroterapy).
Anti-Helicobacter therapy regimen:
1) Proton pump inhibitors (Pariet, Omeprazole 20 mg, 2 times a day) + Amoxicillin (1000 mg, 2 times a day) + Clarithromycin (500 mg, 2 times a day) times);
2) Proton pump inhibitors (Pariet, Omeprazole 20 mg, 2 times a day) + Metronidazole (500 mg, 2 times a day) + Clarithromycin (500 mg, 2 times a day) times).
Three main methods of endoscopic hemostasis (infiltration, i.e., medicinal, physical, and mechanical) were used (Fig. 2).
Figure 2. Types and photo of endoscopic hemostasis

3. Research Results

Out of 105 patients, 64 patients underwent EGDS once, 20 patients underwent EGDS twice (for suspected bleeding and for monitoring in dynamics), and 21 patients (with bleeding complications) underwent EGDS 3-5 times. Conclusions and results of single and multiple EGDS. Gastric erosions in 6 (6%) patients, duodenal erosions in 9 (8.5%) patients, uncomplicated acute and chronic gastric ulcers in 15 (14%) patients, duodenal ulcers in 23 (22.1%) patients, combined ulcers in 11 (10.4%) patients, Complicated bleeding ulcers FIa-2 (2%) patients, FIb-4 (3.8%) patients, FIIa-5 (4.7%) patients, FIIb-4 (3.8%) patients, FIIc-6 (5.7%) patients, FIII - 18 (17.1%) patients with the above-mentioned ulcers but without complications, wound perforation in 2 (1.9%) patients (Table 1).
Table 1. Results of the first and repeated endoscopic examination of the gastrointestinal tract
     
The majority of the victims were 64 patients who underwent single EGDS and 8 patients who underwent double EGDS in the 1st group (15-25% of the width and depth of the burn area). 18 patients with repeated EGDS, 21 with complications (bleeding), and 2 patients with perforation were in the 2nd group (30-50% of the width and depth of the burn area).
In 64 patients who underwent single EGDS and 20 patients who underwent double EGDS, erosive changes and uncomplicated ulcers of various sizes in the stomach and duodenum were detected, and according to the above-mentioned Maastricht recommendations, treatment was carried out on a standard basis using the first-line scheme for the eradication of Helicobacter pylori and conservative treatment (quadroterapy), as a result of which a complete positive result was achieved in eliminating pathologies related to the gastrointestinal tract in all our patients. In 21 patients with bleeding complications, infiltration (sodium chloride 0.9%-8ml + adrenaline 1%-1ml), physical electrocoagulation), mechanical (clipping) and combined (infiltration, physical and mechanical) methods of endoscopic hemostasis were used in combination depending on the intensity of bleeding, conservative treatment was also carried out for the purpose of complex treatment, and a complete positive result was achieved. Two patients with wound perforation underwent minimally invasive laparoscopic wound suturing.
Treatment of bleeding from erosions and ulcers of the gastrointestinal tract in burn patients was aimed at 3 main goals (hemostasis, prevention of recurrent bleeding, elimination of the consequences of acute blood loss). As indicated, repeated and periodic diagnostic and therapeutic EGDS was performed, which continued until the complete disappearance of endoscopic signs of active bleeding in erosions and ulcers (Fig. 3).
Figure 3. Image and effect of endoscopic hemostasis

4. Discussion of Results

Diseases (erosions and ulcers, perforations) of the gastrointestinal tract in patients with severe burns, accompanied by organic changes in the mucous membrane, are one of the urgent and complex problems of medicine, and acute gastroduodenal erosions and ulcers are etiopathogenetically associated with the use of ulcerative drugs and psycho-emotional stress observed in burn disease. Disruption of local blood circulation contributes to the development of hypoxia and reduces the resistance of the gastroduodenal mucosa to acid-peptic aggression. In the last decade, acute gastroduodenal erosions and ulcers have become the leading cause of gastrointestinal bleeding in patients with severe burns [3-6].
Prophylactic EGDS, continuous prophylactic use of gastric secretion blockers, antacids, and cytoprotective agents are used from the first hours after the patient's admission.
The results of the study show that in the acute period of burn disease, effective elimination of hemodynamic disorders, fluid and protein balance reduces the risk of dysproteinemia and intoxication, which leads to trophic disorders of the gastrointestinal tract wall. It is very important to ensure adequate perfusion of organs to prevent the development of acute ulcers and bleeding [4-5].
Our studies have shown that the endoscopic approach in the early prevention and treatment of complications (acute gastroduodenal erosions and ulcers, bleeding, perforation) that develop in patients in the early period within the first 24-48 hours and in the late 3-5 days allows in 70-80% of cases to prevent severe complications associated with the gastrointestinal tract and reduce the number of deaths [10-12]. Using new endoscopic diagnostic and treatment techniques in patients with gastrointestinal dysfunction (acute gastroduodenal erosions and ulcers, bleeding, perforation), especially when active bleeding is detected, allows for immediate endoscopic hemostasis to achieve 90-95% positive results and effectiveness. As a result, the lowest mortality rate associated with this complication decreased from 38% to 19.2%. A positive result was achieved by reducing the time taken to eliminate these complications from 3 to 1.5 days in the early period and from 7 to 5 days in the late period (fig 4).
Figure 4. Effectiveness of the endoscopic approach in the elimination of pathologies in the gastrointestinal tract

5. Conclusions

1. The endoscopic approach plays an important role in the early prevention, treatment, and prevention of severe complications of pathologies in the gastrointestinal tract in patients with severe burns.
2. Timely use of endoscopic examination and treatment of patients with severe burns led to a decrease in the lowest mortality rate associated with pathologies in the gastrointestinal tract and their severe complications from 38% to 19.2%.
3. The time taken to eliminate complications associated with the gastrointestinal tract was reduced from 3 to 1.5 days in the early period and from 7 to 5 days in the late period.
Information about the source of support in the form of grants, equipment, and drugs. The authors did not receive financial support from manufacturers of medicines and medical equipment.
Conflicts of interest. The authors have no conflicts of interest.

References

[1]  Matveeva UV, Revazova AB, Boraeva TT, Albegova BZ, Kurbanmagomedova AD, Galaev IK, Nauruzova DM, Balayeva MB, Kutsenko EY, Kadyrova YS. Bleeding in erosive and ulcerative lesions of the upper digestive tract in children. International Transaction Journal of Engineering, Management and Applied Sciences and Technologies. 2022 Mar; 13(8): 13A8C.
[2]  Camilleri MJ. Cutaneous diseases of the esophagus. The Esophagus. 2021 Jul 9:789-803.
[3]  Beresneva E, Spridonova T, Zhirkova E. The importance of X-ray in examination of lungs in patients with inhalation trauma. Russ Sklifovosky J Emerg Med Care. 2019 Nov 5; 8(3): 279-87. (in Russian) DOI: https://doi.org/10.23934/2223-9022-2019-8-3-279-287.
[4]  Szentgyorgyi L, Shepherd C, Dunn KW, Fawcett P, Barker JM, Exton P, Maybauer MO. Extracorporeal membrane oxygenation in severe respiratory failure resulting from burns and smoke inhalation injury. Burns. 2018 Aug 1; 44(5): 1091-9. DOI: https://doi.org/10.1016/j.burns.2018.01.022.
[5]  Koshkareva YA, Hughes WB, Soliman AM. Laryngotracheal stenosis in burn patients requiring mechanical ventilation. World journal of otorhinolaryngology-head and neck surgery. 2018 Jun 1; 4(2): 117-21. DOI: https://doi.org/10.1016/j.wjorl.2018.05.004.
[6]  Choi JH, Chou LD, Roberts TR, Beely BM, Wendorff DS, Espinoza MD, Sieck K, Dixon AT, Burmeister D, Jordan BS, Brenner M. Point-of-care endoscopic optical coherence tomography detects changes in mucosal thickness in ARDS due to smoke inhalation and burns. Burns. 2019 May 1; 45(3): 589-97. DOI: https://doi.org/10.1016/j.burns.2018.10.014.
[7]  Gill P, Falder S. Early management of paediatric burn injuries. Paediatrics and Child Health. 2017 Sep 1; 27(9): 406-14. DOI: https://doi.org/10.1016/j.paed.2017.03.011.
[8]  Shakirov BM, Ashurova N. Our Experience Treatment Inhalation Injury in Children in Uzbekistan. International J of Pediatr Res. 2020; 6: 070. DOI: 10.23937/2469-5769/1510070.
[9]  Shen Y, Fu L, Yue Z, Shi W, Li C, Zhang C. First aid treatment and airway management for chemical burns combined with inhalation injury: A case report. Respirology Case Reports. 2024 Dec; 12(12): e70094. DOI: https://doi.org/10.1002/rcr2.70094.
[10]  Tang JA, Amadio G, Nagappan L, Schmalbach CE, Dion GR. Laryngeal inhalational injuries: a systematic review. Burns. 2022 Feb 1; 48(1): 23-33. DOI: https://doi.org/10.1016/j.burns.2021.02.006.
[11]  Clayton NA, Ward EC, Rumbach AF, Cross RR, Kol MR, Maitz PK. Influence of inhalation injury on incidence, clinical profile and recovery pattern of dysphagia following burn injury. Dysphagia. 2020 Dec; 35(6): 968-77. DOI: https://doi.org/10.1007/s00455-020-10098-y.
[12]  Desai SR, Zeng D, Chong SJ. Airway management in inhalation injury: a case series. Singapore Medical Journal. 2020 Jan; 61(1): 46. DOI: 10.11622/smedj.2019048.
[13]  Orozco-Peláez YA. Airway burn or inhalation injury: should all patients be intubated?. Colombian Journal of Anesthesiology. 2018 Apr 1; 46(2S): 26-31. DOI: 10.1097/CJ9.0000000000000042.
[14]  Woodson LC, Branski LK, Enkhbaatar P, Talon M. Diagnosis and treatment of inhalation injury. InTotal burn care 2018 Jan 1 (pp. 184-194). Elsevier. DOI: https://doi.org/10.1016/B978-0-323-47661-4.00017-4.
[15]  Makarov AV, Zhirkova EA, Spiridonova TG, Mironov AV. Possibilities of Endoscopic Diagnosis of Airway Burn in Inhalation Trauma. Russian Sklifosovsky Journal" Emergency Medical Care". 2020 Oct 18; 9(1): 46-50. (in Russian) DOI: https://doi.org/10.23934/2223-9022-2020-1-46-50.