Medical records of 18 patients with spontaneous bacterial peritonitis (SBP) and 19 patients with culture negative neutrocytic ascites (CNNA) were reviewed. The diagnosis of SBP was based on a positive ascitic fluid culture, a polymorphonuclear cell count (PMN) greater than 250 cells/mm3 and the absence of an intra-abdominal source of infection. The diagnosis of CNNA was based on a PMN count greater than 250 cells/mm3, a negative ascitic fluid culture, the absence of an intra-abdominal source of infection and no antibiotic treatment in the preceding 30 days. All patients in both groups had liver cirrhosis, which was mainly (62.2%) due to HBV infection. A single strain, mostly 'a Gram-negative' bacillus, was recovered from the ascitic fluid culture in the vast majority of patients (83%) with SBP. There were no significant differences between the clinical data of both groups. However, the CNNA group had a significantly better Pugh score (P value = 0.01) with a mean score of 9.42 +/- 2.24, compared to the SBP group (10.94 +/- 2.88). The only significant difference in the laboratory data was that the total bilirubin was higher in the SBP group (P < 0.01). Hospital mortality was significantly higher in the SBP patients compared to those with CNNA, 50 and 16%, respectively (P < 0.03). Recurrent ascitic fluid infection occurred in one of five patients who initially presented. In contrast no recurrence was documented in 12 patients with CNNA. Spontaneous bacterial peritonitis is a serious complication of liver cirrhosis with significantly higher mortality than CNNA. A single organism, usually enteric, is the most common causative agent.

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To find the frequency of peptic ulceration in portal hypertension, 137 patients with portal hypertension were studied retrospectively. Patients with hepatocellular carcinoma, other malignancies or underlying severe systemic disease were excluded and the remaining 114 patients were included in the study. There were 81 males (mean age 49.1 ± 13.7 years) and 33 females (mean age 52.9 ± 10 years). Portal hypertension was secondary to viral liver disease in 75%. Fifty-seven patients had no evidence of peptic ulcers (group I) and another 57 patients (group II) had peptic ulcers diagnosed during upper gastrointestinal endoscopy. There was no significant difference between the two groups regarding age, sex, Child-Pugh score or variceal size. Duodenal ulcers were found in 24% while gastric ulcers were found in 4.4%; other endoscopic findings included erosive gastritis and duodenitis in 21% and 18.4% respectively. Twelve percent of the patients from group II developed bleeding from the ulcers and the majority of bleeding ulcers responded to conservative treatment. The study concludes that the frequency of peptic ulcers in patients with portal hypertension is high. Bleeding peptic ulcers respond to conservative treatment. Ann Saudi Med 1995;15 (5) The incidence of peptic ulcer disease in cirrhotic patients has been reported to range from 8% to 20%.1-4 The complication rate and mortality are also increased in such patients.1 Suggested pathogenesis of peptic ulcers in patients with cirrhosis includes increased levels of gastrin and histamine, the presence of Helicobacter pylori, increased duodenogastric reflux, impaired gastric emptying, reduced prostaglandin level in gastric mucosa and reduced mucosal oxygen saturation. 1,[5][6][7][8][9] Most of the former studies have been performed in alcoholic-related etiologies, mainly liver cirrhosis. 10Therefore, we conducted our study to find out the frequency of peptic ulcer disease in patients with portal hypertension of different etiologies, mainly nonalcoholic. Patients and MethodsOne hundred and thirty-seven consecutive patients with portal hypertension diagnosed at the Gastroenterology Unit of King Khalid University Hospital between AH 1413 to AH 1414 were included. Twenty-three patients subsequently were excluded because of the presence of hepatocellular carcinoma, gastric carcinoma or severe systemic disease such as end stage renal failure or end stage respiratory and cardiac disease.The remaining 114 patients entered the study. There were 81 males (mean age 49.1 ± 13.7 years) and 33 females (mean age 52.9 ± 10 years). The diagnosis of portal hypertension was based on the presence of prominent submucosal veins that protrude into the esophageal lumen. Esophageal varices were graded on a scale from 1 to 4 according to size. The diagnosis of portal hypertension was substantiated with upper abdominal ultrasonography. An ulcer was defined as the presence of an ulcer crater.The patient's history was reviewed regarding the presence of abdominal pain, hematemesis or melena, smoking h...