Affiliation:
1. MD,DM Professor and Head Department of Medical Gastroenterology Government Stanley Medical College , Chennai , India
2. MD Resident Department of Medical Gastroenterology Government Stanley Medical College , Chennai , India.
3. MD,DM Associate Professor Department of Medical Gastroenterology Government Stanley Medical College , Chennai , India.
4. MD,DM Assistant Professor Department of Medical Gastroenterology Government Stanley Medical College , Chennai , India
Abstract
Background: Peptic ulcer disease in patients with liver cirrhosis poses significant morbidity and mortality . It is also a cause for gastrointestinal bleed . Our study aims at providing a clinical and endoscopic profile of peptic ulcer disease in patients suffering from liver cirrhosis .
Objective: Providing an insight into the clinical and endoscopic profile of patients suffering from liver cirrhosis and peptic ulcer disease, with special reference to Child Pugh score, spontaneous bacterial peritonitis, refractory ascites and other comorbidities.
Methods: This study was conducted in the Department of Medical Gastroenterology, Govt Stanley medical college, Chennai from September 2018 to April 2019. All cirrhotic patients underwent relevant blood investigations, ultrasound abdomen, portal vein doppler and upper GI endoscopy. Gastric ulcers were biopsied according to standard protocol. RUT was not performed in all cases for H.Pylori detection .
Results: A total of 361 cirrhotic patients that underwent upper GI endoscopy, 45 patients were incuded in our study based on the inclusion criteria. The prevalence of peptic ulcer disease in liver cirrhotics was 12.4% . Males to females ratio of 38:7. Mean age was 38 years ±2.8. Mean CTP score was 8.42±1.90 . median of 8 , mode 10 . Ascites was noted in 37, SBP in 22 and refractory ascites in 4. Etiology for cirrhosis was alcohol (44.4%) , cryptogenic(17.8%) , hepatitis B(15.6%) , Budd Chiari syndrome(8.9%) , hepatitis C(4.4%), wilsons disease (2.2%) , secondary biliary cirrhosis(2.2%) , autoimmune hepatitis(2.2%) . 23 had CPT score B, followed by CPT C in 15 and CPT A in 7 .
Conclusion: In conclusion, a significant proportion of patients with cirrhosis develop PUD. Furthermore, H pylori infection and NSAIDs are not the only, or perhaps even the most important, risk factors for PUD in patients with cirrhosis. These observations have important practical implications for physicians caring for patients with chronic liver disease.