Диагностика и лечение язвенной болезни у взрослых (Клинические рекомендации Российской гастроэнтерологической ассоциации, Российского общества колоректальных хирургов, Российского эндоскопического общества и Научного сообщества по содействию клиническому изучению микробиома человека)

Цель. В клинических рекомендациях, предназначенных для врачей-гастроэнтерологов, врачей общей практики (семейных врачей), врачей-терапевтов, хирургов, эндоскопистов, изложены современные методы диагностики и лечения язвенной болезни.

Основное содержание. Клинические рекомендации содержат современные представления об этиологии и патогенезе язвенной болезни, ее клинических особенностях, методах лабораторной и инструментальной диагностики, основных подходах к консервативному и хирургическому лечению. В них приводятся критерии оценки качества оказания медицинской помощи, алгоритм действий врача, а также информация для пациента.

Заключение. Знание врачами современных методов диагностики и терапии язвенной болезни будет способствовать улучшению результатов ее лечения.

1. Shay H., Sun D.C.H. Etiology and pathology of gastric and duodenal ulcer. In: Bockus H.L. Gastroenterology. Philadelphia-London: Saunders Elsevier. 1968:420–65.

2. Lanas A., Chan F.K.L. Peptic ulcer disease. Lancet. 2017;390(10094):613–24. DOI: 10.1016/S0140-6736(16)32404-7

3. Chan F.K.L., Lau J.Y.W. Peptic ulcer disease. In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 10th ed. Philadelphia: Saunders Elsevier, 2015.

4. Ramakrishnan K., Salinas R.C. Peptic ulcer disease. Am Fam Physician. 2007;76(7):1005–12.

5. Василенко В.Х., Гребенев А.Л., Шептулин А.А. Язвенная болезнь. М.: Медицина, 1987.

6. Lau J.Y., Sung J., Hill C., Henderson C., Howden C.W., Metz D.C. Systematic review of the epidemiology of complicated peptic ulcer disease: Incidence, recurrence, risk factors and mortality. Digestion. 2011;84(2):102–13. DOI: 10.1159/000323958

7. Заболеваемость всего населения России в 2006 г. Статистические материалы Минздрава России. М., 2007:98.

8. Заболеваемость всего населения России в 2018 г. Статистические материалы Минздрава России. М., 2018:101.

9. Hawkey C.J., Wight N.J. Clinician’s manual on NSAIDS and gastrointestinal complications. London: Life Science Communications, 2001.

10. Nagashima K., Tominaga K., Fukushi K., Kanamori A., Sasai T., Hiraishi H. Recent trends in the occurrence of bleeding gastric and duodenal ulcers under the Japanese evidence-based clinical practice guideline for peptic ulcer disease. JGH Open. 2018;2(6):255–61. DOI: 10.1002/jgh3.12078

11. Горбашко А.И. Диагностика и лечение кровопотери. Л., Медицина, 1982.

12. Heldwein W., Schreiner J., Pedrazzoli J., Lehnert P. Is the Forrest classification a useful tool for planning endoscopic therapy of bleeding peptic ulcers? Endoscopy. 1989;21(6):258–62. DOI: 10.1055/s-2007-1010729

13. Ивашкин В.Т., Шептулин А.А. Болезни пищевода, желудка и кишечника. М.: МЕДпресс-информ, 2009.

14. Tomizawa M., Shinozaki F., Hasegawa R., Shirai Y., Motoyoshi Y., Sugiyama T., et al. Low hemoglobin levels are associated with upper gastrointestinal bleeding. Biomed Rep. 2016;5(3):349–52. DOI: 10.3892/br.2016.727

15. Harewood G.C., McConnel J.P., Harrington J.J., Mahoney D.W., Ahlquist D.A. Detection of occult upper gastrointestinal bleeding: Performance differences in fecal occult blood tests. Mayo Clin Proc. 2002;77(1):23–8. DOI: 10.4065/77.1.23

16. Baghdanian A.H., Baghdanian A.A., Puppala A.A., Tana M., Ohliger M.A. Imaging manifestations of peptic ulcer disease on computed tomography. Semin Ultrasound CT MR. 2018;39(2):183–92. DOI: 10.1053/j.sult.2017.12.002

17. Ecanow J.S., Gore R.M. Evaluating patients with left upper quadrant pain. Radiol Clin North Am. 2015;53(6):1131–57. DOI: 10.1016/j.rcl.2015.06.003

18. Thorsen K., Glomsaker T.B., von Meer A., Søreide K., Søreide J.A. Trends in diagnosis and surgical management of patients with perforated peptic ulcer. J Gastrointest Surg. 2011;15(8):1329–35. DOI: 10.1007/s11605-011-1482-1

19. Ishiguro T., Kumagai Y., Baba H., Tajima Y., Imaizumi H., Suzuki O., et al. Predicting the amount of intraperitoneal fluid accumulation by computed tomography and its clinical use in patients with perforated peptic ulcer. Int Surg. 2014;99(6):824–9. DOI: 10.9738/INTSURG-D-14-00109.1

20. Picone D., Rusignuolo R., Midiri F., Lo Casto A., Vernuccio F., Pinto F., et al. Imaging assessment of gastroduodenal perforations. Semin Ultrasound CT MR. 2016;37(1):16–22. DOI: 10.1053/j.sult.2015.10.006

21. Coppolino F., Gatta G., Di Grezia G., Reginelli A., Iacobellis F., Vallone G., et al. Gastrointestinal perforation: Ultrasonographic diagnosis. Crit Ultrasound J. 2013;5(Suppl 1):S4. DOI: 10.1186/2036-7902-5-S1-S4

22. Barkun A.N., Bardou M., Kuipers E.J., Sung J., Hunt R.H., Martel M., et al. International consensus recommendations on the management of patients with nonvariceal upper gastrointestinal bleeding. Ann Intern Med. 2010;152(2):101–13. DOI: 10.7326/0003-4819-152-2-201001190-00009

23. Язвенные гастродуоденальные кровотечения. Клинические рекомендации Российского общества хирургов. Воронеж, 2014:1–9.

24. Jiang M., Chen P., Gao Q. Systematic review and network meta-analysis of upper gastrointestinal hemorrhage interventions. Cell Physiol Biochem. 2016;39(6):2477–91. DOI: 10.1159/000452515

25. Barkun A.N., Martel M., Toubouti Y., Rahme E., Bardou M. Endoscopic hemostasis in peptic ulcer bleeding for patients with high-risk lesions: A series of meta-analyses. Gastrointest Endosc. 2009;69(4):786–99. DOI: 10.1016/j.gie.2008.05.031

26. Malfertheiner P., Megraud F., Rokkas T., Gisbert J.P., Liou J.-M., Schulz C., et al. Management of Helicobacter pylori infection: The Maastricht VI/Florence consensus report. Gut. 2022;71:1724–62. DOI: 10.1136/gutjnl-2022-327745

27. Best L.M., Takwoingi Y., Siddique S., Selladurai A., Gandhi A., Low B., et al. Non-invasive diagnostic tests for Helicobacter pylori infection. Cochrane Database Syst Rev. 2018;3(3):CD012080. DOI: 10.1002/14651858. CD012080.pub2

28. Gisbert J.P., Abraira V. Accuracy of Helicobacter pylori diagnostic tests in patients with bleeding peptic ulcer: A systematic review and meta-analysis. Am J Gastroenterol. 2006;101(4):848–63. DOI: 10.1111/j.1572-0241.2006.00528.x

29. Kim Н. Diagnostic and treatment approaches for refractory ulcers. Clin Endoscop. 2015;48(4):285–90. DOI: 10.5946/ce.2015.48.4.285

30. Vomero M.D., Colpo E. Nutritional care in peptic ulcer. Arq Bras Cir Dig. 2014;27(4):298–302. DOI: 10.1590/S0102-67202014000400017

31. Burget D.W., Chiverton K.D., Hunt R.H. Is there an optimal degree of acid supрression for healing of duodenal ulcers? A model of the relationship between ulcer healing and acid suppression. Gastroenterology. 1990;99(2):345– 51. DOI: 10.1016/0016-5085(90)91015-x

32. Scally B., Emberson J.R., Spata E., Reith C., Davies K., Halls H., et al. Effects of gastroprotectant drugs for the prevention and treatment of peptic ulcer disease and its complications: A meta-analysis of randomized trials. Lancet Gastroenterol Hepatol. 2018;3(4):231–41. DOI: 10.1016/S2468-1253(18)30037-2

33. Poinard T., Lemaire M., Agostini H. Meta-analysis of randomized clinical trials comparing lansoprazole with ranitidine or famotidine in the treatment of acute duodenal ulcer. Eur J Gastroenterol Hepatol. 1995;7(7):661–5.

34. Hu Z.H., Shi A.M., Hu D.M., Bao J.J. Efficacy of proton pump inhibitors for patients with duodenal ulcers: A pairwise and network meta-analysis of randomized controlled trial. Saudi J Gastroenterol. 2017;23(1):11–9. DOI: 10.4103/1319-3767.199117

35. Terano A., Arakawa Y., Sugiyama H., Suzuki H., Joh T., Yoshikawa T., et al. Rebamipide, a gastro-protective and anti-inflammatory drug, promotes gastric ulcer healing following eradication therapy for Helicobacter pylori in a Japanese population: A randomized, double-blind, placebo-controlled trial. J Gastroenterol. 2007;42(8):690–3. DOI: 10.1007/s00535-007-2076-2

36. Song K.H., Lee J.C., Fan D.M., Ge Z.Z., Ji F., Chen M.H., et al. Healing effects of rebamipide and omeprazole in Helicobacter pylori-positive gastric ulcer patients after eradication therapy: A randomized double-blind, multinational comparative study. Digestion. 2011;84(3):221–9. DOI: 10.1159/000329353

37. Ford A.C., Gurusamy K.S., Delaney B., Forman D., Moayyedi P. Eradication therapy for peptic ulcer disease in Helicobacter pylori-positive people. Cochrane Database Syst Rev. 2016;4(4):CD003840. DOI: 10.1002/14651858. CD003840.pub5

38. Wong C.S., Chia C.F., Lee H.C., Wei P.L., Ma H.P., Tsai S.H., et al. Eradication of Helicobacter pylori for prevention of ulcer recurrence after simple closure of perforated peptic ulcer: A meta-analysis of randomized controlled trials. J Surg Res. 2013;182(2):219–26. DOI: 10.1016/j. jss.2012.10.046

39. Ивашкин В.Т., Маев И.В., Лапина Т.Л., Шептулин А.А., Трухманов А.С., Баранская Е.К. и др. Клинические рекомендации Российской гастроэнтерологической ассоциации по диагностике и лечению инфекции Helicobacter pylori у взрослых. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2018;28(1):55–70. DOI: 10.22416/1382-4376-2018-28-1-55-70

40. Ko S.W., Kim Y.-J., Chung W.C., Lee S.J. Bismuth supplements as the first-line regimen for Helicobacter pylori eradication therapy: Systemic review and meta-analysis. Helicobacter. 2019;24(2):e12565. DOI: 10.1111/ hel.12565

41. McNicholl A.G., Bordin D.S., Lucendo A., Fadeenko G., Fernandez M.C., Voynovan I., et al. Combination of bismuth and standard triple therapy eradicates Helicobacter pylori infection in more than 90 % of patients. Clin Gastroenterol Hepatol. 2020;18(1):89–98. DOI: 10.1016/j.cgh.2019.03.048

42. Nyssen O.P., Bordin D., Tepes B., Pérez-Aisa Á., Vaira D., Caldas M., et al. European Registry on Helicobacter pylori management (Hp-EuReg): Patterns and trends in first-line empirical eradication prescription and outcomes of 5 years and 21 533 patients. Gut. 2021;70(1):40–54. DOI: 10.1136/gutjnl-2020-321372

43. Yang X., Wang J.X., Han S.X., Gao C.P. High dose dual therapy versus bismuth quadruple therapy for Helicobacter pylori eradication treatment: A systematic review and meta-analysis. Medicine (Baltimore). 2019;98(7):e14396. DOI: 10.1097/MD.0000000000014396

44. Guo B., Cao N.W., Zhou H.Y., Chu X.J., Li B.Z. Efficacy and safety of bismuth-containing quadruple treatment and concomitant treatment for first-line Helicobacter pylori eradication: A systematic review and meta-analysis. Microb Pathog. 2021;152:104661. DOI: 10.1016/j.micpath.2020.104661

45. Yuan Y., Ford A.C., Khan K.J., Gisbert J.P., Forman D., Leontiadis G.I., et al. Optimum duration of regimens for Helicobacter pylori eradication. Cochrane Database Syst Rev. 2013;12:CD008337. DOI: 10.1002/14651858. CD008337.pub2

46. Villoria A., Garcia P., Calvet X., Gisbert J.P., Vergara M. Meta-analysis: High-dose proton pump inhibitors vs. standard dose in triple therapy for Helicobacter pylori eradication. Aliment Pharmacol Ther. 2008;28(7):868–77. DOI: 10.1111/j.1365-2036.2008.03807.x

47. Gao W., Zhang X., Yin Y., Yu S., Wang L. Different dose of new generation proton pump inhibitors for the treatment of Helicobacter pylori infection: A meta-analysis. Int J Immunopathol Pharmacol. 2021;35:20587384211030397. DOI: 10.1177/20587384211030397

48. Tang H.L., Li Y., Hu Y.F., Xie H.G., Zhai S.D. Effects of CYP2C19 loss-of-function variants on the eradication of H. pylori infection in patients treated with proton pump inhibitor-based triple therapy regimens: A meta-analysis of randomized clinical trials. PLoS One. 2013;8(4):e62162. DOI: 10.1371/journal.pone.0062162

49. Jung Y.S., Kim E.H., Park C.H. Systematic review with meta-analysis: The efficacy of vonoprazan-based triple therapy on Helicobacter pylori eradication. Aliment Pharmacol Ther. 2017;46(2):106–14. DOI: 10.1111/apt.14130

50. Shinozaki S., Kobayashi Y., Osawa H., Sakamoto H., Hayashi Y., Lefor A.K., et al. Effectiveness and safety of vonoprazan versus proton pump inhibitors for second-line Helicobacter pylori eradication therapy: Systematic review and meta-analysis. Digestion. 2021;102(3):319–25. DOI: 10.1159/000504939

51. Chang Y.L., Tung Y.C., Tu Y.K., Yeh H.Z., Yang J.C., Hsu P.I., et al. Efficacy of second-line regimens for Helicobacter pylori eradication treatment: A systemic review and network meta-analysis. BMJ Open Gastroenterol. 2020;7(1):e000472. DOI: 10.1136/bmjgast-2020-000472

52. Han Z., Li Y., Kong Q., Liu J., Wang J., Wan M., et al. Efficacy of bismuth for antibiotic-resistant Helicobacter pylori strains eradication: A systematic review and meta-analysis. Helicobacter. 2022;27(6):e12930. DOI: 10.1111/hel.12930

53. Yeo Y.H., Hsu C.C., Lee C.C., Ho H.J., Lin J.T., Wu M.S., et al. Systematic review and network meta-analysis: Comparative effectiveness of therapies for second-line Helicobacter pylori eradication. J Gastroenterol Hepatol. 2019;34(1):59–67. DOI: 10.1111/jgh.14462

54. Mori H., Suzuki H. Update on quinolone-containing rescue therapies for Helicobacter pylori infection. World J Gastroenterol. 2020;26(15):1733–44. DOI: 10.3748/wjg.v26.i15.1733

55. Nishizawa T., Nishizawa Y., Yahagi N., Kanai T., Takahashi M., Suzuki H. Effect of supplementation with rebamipide for Helicobacter pylori eradication therapy: A systematic review and meta-analysis. J Gastroenterol Hepatol. 2014;29(Suppl. 4):20–4. DOI: 10.1111/jgh.12769

56. Andreev D.N., Maev I.V., Dicheva D.T. Efficiency of the inclusion of rebamipide in the eradication therapy for Helicobacter pylori infection: Meta-analysis of randomized controlled studies. J Clin Med. 2019;8(9):1498. DOI: 10.3390/jcm8091498

57. Graham D.Y., Lew G.M., Malaty H.M., Evans D.G., Evans D.J.Jr., Klein P.D., et al. Factors influencing the eradication of Helicobacter pylori with triple therapy. Gastroenterology. 1992;102(2):493–6. DOI: 10.1016/0016-5085(92)90095-g

58. Kim B.J., Lee H., Lee Y.C., Jeon S.W., Kim G.H., Kim H.S., et al. Ten-day concomitant, 10-day sequential, and 7-day triple therapy as first-line treatment for Helicobacter pylori infection: A nationwide randomized trial in Korea. Gut Liver. 2019;13(5):531–40. DOI: 10.5009/gnl19136

59. Минушкин О.Н., Зверков И.В., Володин Д.В., Иванова Е.И., Шулешова А.Г. Эффективность препарата «Пилобакт AM» в эрадикационной терапии язвенной болезни двенадцатиперстной кишки. Врач. 2008;5:67–9.

60. McFarland L.V., Malfertheiner P., Huang Y., Wang L. Meta-analysis of single strain probiotics for the eradication of Helicobacter pylori and prevention of adverse events. World Journal of Meta-Analysis. 2015;3(2):97–117. DOI: 10.13105/wjma.v3.i2.97

61. Zhou B.G., Chen L.X., Li B., Wan L.Y., Ai Y.W. Saccharomyces boulardii as an adjuvant therapy for Helicobacter pylori eradication: A systematic review and meta-analysis with trial sequential analysis. Helicobacter. 2019;24(5):e12651. DOI: 10.1111/hel.12651

62. McFarland L.V., Huang Y., Wang L., Malfertheiner P. Systematic review and meta-analysis: Multi-strain probiotics as adjunct therapy for Helicobacter pylori eradication and prevention of adverse events. United European Gastroenterol J. 2016;4(4):546–61. DOI: 10.1177/2050640615617358

63. Szajewska H., Horvath A., Piwowarczyk A. Meta-analysis: The effects of Saccharomyces boulardii supplementation on Helicobacter pylori eradication rates and side effects during treatment. Aliment Pharmacol Ther. 2010;32(9):1069–79. DOI: 10.1111/j.1365-2036.2010.04457.x

64. Szajewska H., Horvath A., Kołodziej M. Systematic review with meta-analysis: Saccharomyces boulardii supplementation and eradication of Helicobacter pylori infection. Aliment Pharmacol Ther. 2015;41(12):1237–45. DOI: 10.1111/apt.13214

65. Dang Y., Reinhardt J.D., Zhou X., Zhang G. The effect of probiotics supplementation on Helicobacter pylori eradication rates and side effects during eradication therapy: A meta-analysis. PLoS One. 2014;9(11):e111030. DOI: 10.1371/journal.pone.0111030

66. Lv Z., Wang B., Zhou X., Wang F., Xie Y., Zheng H., et al. Efficacy and safety of probiotics as adjuvant agents for Helicobacter pylori infection: A meta-analysis. Exp Ther Med. 2015;9(3):707–16. DOI: 10.3892/etm.2015.2174

67. Zheng X., Lyu L., Mei Z. Lactobacillus-containing probiotic supplementation increases Helicobacter pylori eradication rate: Evidence from a meta-analysis. Rev Esp Enferm Dig. 2013;105(8):445–53. DOI: 10.4321/s1130-01082013000800002

68. Goodman C., Keating G., Georgousopoulou E., Hespe C., Levett K. Probiotics for the prevention of antibiotic-associated diarrhoea: A systematic review and meta-analysis. BMJ Open. 2021;11(8):e043054. DOI: 10.1136/bmjopen-2020-043054

69. Goldenberg J.Z., Yap C., Lytvyn L., Lo C.K., Beardsley J., Mertz D., et al. Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children. Cochrane Database Syst Rev. 2017;12(12):CD006095. DOI: 10.1002/14651858.CD006095.pub4

70. Cárdenas P.A., Garcés D., Prado-Vivar B., Flores N., Fornasini M., Cohen H., et al. Effect of Saccharomyces boulardii CNCM I-745 as complementary treatment of Helicobacter pylori infection on gut microbiome. Eur J Clin Microbiol Infect Dis. 2020;39(7):1365–72. DOI: 10.1007/s10096-020-03854-3

71. Seddik H., Boutallaka H., Elkoti I., Nejjari F., Berraida R., Berrag S., et al. Saccharomyces boulardii CNCM I-745 plus sequential therapy for Helicobacter pylori infections: A randomized, open-label trial. Eur J Clin Pharmacol. 2019;75(5):639–45. DOI: 10.1007/s00228-019-02625-0

72. Martín R., Langella P. Emerging health concepts in the probiotics field: Streamlining the definitions. Front Microbiol. 2019;10:1047. DOI: 10.3389/fmicb.2019.01047

73. Shenderov B.A. Metabiotics: Novel idea or natural development of probiotic conception. Microb Ecol Health Dis. 2013:24. DOI: 10.3402/mehd.v24i0.20399

74. Parth K., Prudhivi R., Palatheeya S., Abbas S.K., Varsha K., Niharika B.V., et al. Efficacy of Lactobacillus reuteri supplementation in eradication of H. pylori: A comparison study with triple drug therapy. J Pharm Res Inter. 2021;33(52B):151–9.

75. Toewas I., George A.T., Peter J.V., Kirubakaran R., Fontes L.E.S., Ezekiel J.P.B., et al. Interventions for preventing upper gastrointestinal bleeding in people admitted to intensive care units. Cochrane Datadase Syst Rev. 2018;6(6):CD008687. DOI: 10.1002/14651858. CD008687.pub2

76. Евсеев М.А., Клишин И.М. Эффективность антисекреторной терапии ингибиторами протонной помпы при гастродуоденальных язвенных кровотечениях. Российский журнал гастроэнтерологии, гепатологии, колопроктологии. 2010;20(3):55–62.

77. Syam A.F., Setiawati A. Safety and efficacy of lansoprazole injection in upper gastrointestinal bleeding: A postmarketing surveillance conducted in Indonesia. Acta Med Indones. 2013;45(2):123–9.

78. Barkun A., Almadi M., Kuipers E.J., Laine L., Sung J., Tse F., et al. Management of nonvariceal upper gastrointestinal bleeding: Guideline recommendations from the international consensus group. Ann Inter Med. 2019:171(11):805–22. DOI: 10.7326/M19-1795

79. Tarasconii A., Coccolini F., Biffl W.L., Tomasoni M., Ansaloni L., Picetti E., et al. Perforated and bleeding peptic ulcer: WSES guidelines. World J Emerg Surg. 2020;15:3. DOI: 10.1186/s13017-019-0283-9

80. Sung J.J.Y, Chiu P.W.Y., Chan F.K.L., Lau J.Y., Goh K.L., Ho L.H., et al. Asia-Pacific working group consensus on non-variceal upper gastrointestinal bleeding. Gut. 2018;67(10):1757–68. DOI: 10.1136/gutjnl-2018-316276

81. Elmunzer B.J., Young S.D., Inadoni J.M., Schoenfeld P., Laine L. Systematic review of the predictors of recurrent hemorrhage after endoscopic hemostatic therapy for bleeding peptic ulcers. Am J Gastroenterol. 2008;103(10):2625– 32. DOI: 10.1111/j.1572-0241.2008.02070.x

82. Satoh K., Yoshino J., Akamatsu T., Itoh T., Kato M., Kamada T., et al. Evidence-based clinical practice guidelines for peptic ulcer disease 2015. J Gastroenterol. 2016;51(3):177–94. DOI: 10.1007/s00535-016-1166-4

83. Gurusamy K.S., Pallari E. Medical versus surgical treatment for refractory or recurrent peptic ulcer. Cochrane Database Syst Rev. 2016;3(3):CD011523. DOI: 10.1002/14651858.CD011523.pub2

84. Прободная язва у взрослых. Клинические рекомендации Российского общества хирургов. M.: МЗ РФ, 2016.

85. Тарасенко С.В., Зайцев О.В., Кочуков В.П., Копейкин А.А., Натальский А.А., Богомолов А.Ю. Хирургия осложненной язвенной болезни. Воронеж: Проспект, 2015.

86. Chatten K., Pursell H., Banerjee A.K., Soteriadou S., Ang Y. Glasgow Blatchford Score and risk stratifications in acute upper gastrointestinal bleed: Can we extend this to 2 for urgent outpatient management? Clin Med (London). 2018;18(2):118–22. DOI: 10.7861/clinmedicine.18-2-118

87. Farrar F.C. Management of acute gastrointestinal bleeding. Crit Care Nurs Clin North Am. 2018;30(1):55–66. DOI: 10.1016/j.cnc.2017.10.005

88. Leontiadis G.I., Molloy-Bland M., Moayyedi P., Howden C.W. Effect of comorbidity on mortality in patients with peptic ulcer bleeding: Systematic review and meta-analysis. Am J Gastroenterol. 2013;108(3):331–45. DOI: 10.1038/ajg.2012.451

89. Møller M.H., Adamsen S., Thomsen R.W., Møller A.M. Preoperative prognostic factors for mortality in peptic ulcer perforation: A systematic review. Scand J Gastroenterol. 2010;45(7–8):785–805. DOI: 10.3109/00365521003783320

90. Morris D.L., Hawker P.C., Brearley S., Simms M., Dykes P.W., Keighley M.R. Optimal timing of operation for bleeding peptic ulcer: Prospective randomized trial. Br Med J (Clin Res Ed). 1984;288(6426):1277–80. DOI: 10.1136/bmj.288.6426.1277

91. Lagoo J., Pappas T.N., Perez A. A relic or still relevant: The narrowing role for vagotomy in the treatment of peptic ulcer disease. Am J Surg. 2014;207(1):120–6. DOI: 10.1016/j.amjsurg.2013.02.012

92. Søreide K., Thorsen K., Harrison E.M., Bingener J., Møller M.H., Ohene-Yeboah M., et al. Perforated peptic ulcer. Lancet. 2015;386(10000):1288–98. DOI: 10.1016/S0140-6736(15)00276-7

93. Tomtitchong P., Siribumrungwomg B., Vilaichone R.K., Kasetsuwan P., Matsukura N., Chaiyakunapruk N. Systematic review and meta-analysis: Helicobacter pylori eradication therapy after simple closure of perforated duodenal ulcer. Helicobacter. 2012;17(2):148–52. DOI: 10.1111.j.1523-5378.2011.00928.x

94. Sharma V.K., Sahai A.V., Corder F.A., Howden C.W. Helicobacter pylori eradication is superior to ulcer healing with or without maintenance therapy to prevent further ulcer haemorrhage. Aliment Pharmacol Ther. 2001;15(12):1939– 47. DOI: 10.1046/j.1365-2036.2001.01134.x

95. Маев И.В., Самсонов А.А. Язвенная болезнь двенадцатиперстной кишки: различные подходы к современной консервативной терапии. Consilium medicum. 2004;(1):6–11.

96. Бурков С.Г. Заболевания органов пищеварения у беременных. М.: КРОН-ПРЕСС, 1996. ORCID: http//orcid.org/0000-0001-7404-5859

97. Cappell M.S. The fetal safety and clinical efficacy of gastrointestinal endoscopy during pregnancy. Gastroenterol Clin North Am. 2003;32(1):123–79. DOI: 10.1016/s0889-8553(02)00137-1