Abstract :
Background: Due to the extreme risk of death after variceal hemorrhage, endoscopic screening for
varices has been recommended in cirrhotic patients since 1998. Previous studies revealed a higher incidence of
peptic ulcer diseases in cirrhotic patients than those of general population. However, the pathogenesis of peptic
ulcers in liver cirrhosis remains inconclusive.
Objective: To investigate for clinical and epidemiological factors that might play role in the pathogen-
esis of peptic ulcer diseases in cirrhosis and to evaluate for the incidence of peptic ulcers in asymptomatic cirrhotic
patients who underwent endoscopic screening.
Patients and Methods: 114 cirrhotic patients without any evidence of liver cancer were recruited into
the study consecutively from the Gastroenterological clinic for endoscopic screening. Patient history and their
clinical data were collected. Biochemical tests were done prior to the study. Doppler ultrasound was used to assess
the portal vein velocity and portal vein size by a single radiologist. Study patients underwent endoscopic examina-
tion for any abnormalities including esophageal and gastric varices and the presence of peptic ulcers. The presence
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of Helicobacter pylori infection was confirmed by two of the three positive tests of Urease test, histology or C
Urea breath test. Statistical analysis of continuous variables was done with student t-test or non-parametric test as
appropriate. Chi-square or Fisher exact test was used for analysis of discrete variables. P-value <0.05 was consid-
ered to be statistically significant. Multivariate logistic regression analysis was performed further for factors with
p-value <0.20.
Results: Peptic ulcers were detected in 45/114 (39.5%) cases. Comparing between peptic ulcer and non
peptic ulcer groups, there was no statistically difference in mean ages, sex, history of regular alcohol drinking,
smoking, NSAID use, portal vein velocity and portal vein size among the two groups except Helicobacter pylori
infection (p = 0.02) and Child Pugh class (p = 0.08). Multivariate logistic regressioon analysis showed that
Helicobacter pylori infection (OR 3.22; 95%CI 1.3-7.5), and Child-Pugh class B (OR 2.71; 95%CI 1.1-6.9) or class
C (OR 3.85; 95% CI 1.3-11.3) were independently associated with the presence of peptic ulcer diseases in these
patients.
Conclusions: Helicobacter pylori infection and advanced stages of liver cirrhosis are the two impor-
tant factors associated with peptic ulcers in cirrhotic patients. Comparing with the general population, peptic ulcer
diseases are more common in asymptomatic cirrhotic patients who underwent endoscopic screening for varices.
[Thai J Gastroenterol 2004; 5(2): 98-104] |
file/Thai-Journal-of-gastroenterology-vol-5-no-2-1571358.pdf