Duodenal erosions and ulcers in patients with pancreatobiliary obstruction

Abstract

In order to determine whether obstructive pancreatobiliary lesions increase the risk of duodenal erosions and ulcers, the duodenal mucosa of patients with these lesions were prospectively examined before endoscopic retrograde cholangiopancreatography (ERCP). During the study period, 133 patients underwent ERCP for various reasons in the Department of Medicine, The Aga Khan University Hospital. One hundred and twenty-three patients were eligible for final analysis. Sixty-five patients with bilirubin > or = 35 mumol/L and alkaline phosphatase > or = 2.5 times normal levels along with radiological evidence of pancreatobiliary obstruction were included in the obstruction group. Fifty-eight patients who did not fulfil these criteria were used in the control group. Acid peptic lesions, which included erosions and ulcers, were seen in 16 patients of the obstruction group and four patients of the control group (P = 0.016, odds ratio (OR) = 4.41). Patients with carcinoma of the pancreas had a greater number of lesions than the rest of the obstruction group (P = 0.001, OR = 8.75). Individual variables like age, sex, serum bilirubin, alanine aminotransferase, alkaline phosphatase, amylase levels, and duration of jaundice did not increase the vulnerability to acid peptic injury. The degree of obstruction multiplied by duration of jaundice (alkaline phosphatase x days) increased the susceptibility for duodenal disease (P = 0.047). From this data it was concluded that patients with obstructive pancreatobiliary lesions are more prone to acid peptic duodenal lesions.

Predictors of Toxicity in a Randomized Study of Consolidation Chemoradiation Versus Observation After First Line Chemotherapy in Advanced Gall Bladder Cancers

“…Duodenal erosions and ulcers have been reported in patients with pancreato-biliary obstruction. 15 The odds of developing ulcers in patients with obstruction was 4.4 and this was more so in those in whom the degree of obstruction multiplied by duration of jaundice was higher. The PTV2 volume was also higher in patients who bled (484 cc) versus 308 cc in those who did not.…”

“…The incidence of stomach or small bowel ulceration was 2%, small bowel obstruction 2%, or GI bleed 15% in a retrospective series of locally advanced extrahepatic biliary cancer where the median RT dose was 50.4 Gy in 28 fractions. 15 …”

“…We included boost in our protocol to escalate radiation doses for superior survival as mentioned by Krishan and others where survival benefit was observed with dose escalation. 15 , 18 They commented that BED >59.5 Gy, elective lymph node irradiation was associated with improvement in OS, and brachytherapy after external RT was associated with inferior OS. The FFCD 9902 trial also suggested a potentially meaningful palliative role for RT with a lower rate of biliary complications (28% vs 44%), such as obstruction with cholangitis, in the cohort receiving CRT compared with chemotherapy alone.…”