Frequency of Peptic Ulcers in Patients with Portal Hypertension

Abstract

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...

Gastroduodenal Lesions Associated with Portal Hypertension: An Extensive Review

“…The damaged protective function of gastric mucosal barrier seems to have a greater role in the pathophysiology of peptic ulcers in cirrhotics, based on the occurrence of chronic atrophyc gastritis in liver cirrhosis, the reduced strength of gastric mucosa due to parietal venous congestion and protein and vitamin deficiencies [52]. Others metabolic and functional modifications should integrate the pathogenetic framework of peptic ulcer in cirrhotic patients: raised level of gastrin and histamine, increase of duodenogastric reflux, impaired gastric empting, reduced prostaglandin level in gastric mucosa and decrease of mucosal oxigen saturation [53,54]. Most recent studies confirm this proposal evaluation referring that the severity degree of liver pathological involvement plays an important role in the development of peptic ulcer disease.…”