Skip to main content

Gastroduodenal Ulcer and Erosions Are Related to Portal Hypertensive Gastropathy and Recent Alcohol Intake in Cirrhotic Patients

Digestive Diseases and Sciences volume 48, pages 1118–1123 (2003)Cite this article

Abstract

Gastroduodenal ulcers and gastroduodenal erosions are particularly frequent in cirrhotic patients, but their precise cause is unclear. The aim of this study was to identify pathogenic factors associated with ulcers and erosions in patients with cirrhosis. We studied 64 consecutive patients with cirrhosis referred for gastroscopy. The severity of portal hypertensive gastropathy was graded with an endoscopic score. H. pylori status was determined by histological examination of gastric biopsy samples or by the [13C] urea breath test. The daily alcohol intake within the preceding week was recorded. The Child-Pugh score was determined. Fifteen patients had gastroduodenal ulcer and 20 had gastroduodenal erosions. Cirrhosis was related to alcohol in 44 patients and hepatitis B or C virus in 14 patients. The portal hypertensive gastropathy was graded as severe in 12 patients and mild in 25 patients. H. pylori infection, found in 37 patients, was not related to the gastroduodenal lesions. Univariate and multivariate analysis showed the links between gastroduodenal erosions and hypertensive gastropathy and recent heavy drinking. Gastroduodenal ulcer was independently associated only with the severity of the gastropathy. In conclusion, in these patients with cirrhosis, the presence of gastroduodenal ulcer was significantly related to hypertensive gastropathy but not to H. pylori infection. Recent alcohol intake favored the occurrence of gastroduodenal erosions.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price includes VAT (USA)
Tax calculation will be finalised during checkout.

References

  1. Siringo S, Burroughs AK, Bolondi L, Muia A, Di Febo G, Miglioli M, Cavalli G, Barbara L: Peptic ulcer and its course in cirrhosis: an endoscopic and clinical prospective study. J Hepatol 22:633-641, 1995

    Google Scholar 

  2. Payen JL, Cales P, Pienkowski P, Sozzani P, Kervran A, Frexinos J, Pascal JP: Weakness of mucosal barrier in portal hypertensive gastropathy of alcoholic cirrhosis. Effects of propranolol and enprostil. J Hepatol 23:689-696, 1995

    Google Scholar 

  3. Rabinovitz M, Yoo YK, Schade RR, Dindzans VJ, Van Thiel DH, Gavaler JS: Prevalence of endoscopic findings in 510 consecutive individuals with cirrhosis evaluated prospectively. Dig Dis Sci 35:705-710, 1990

    Google Scholar 

  4. Friedman GD, Siegelaub AB, Seltzer CC: Cigarettes, alcohol, coffee and peptic ulcer. N Engl J Med 290:469-473, 1974

    Google Scholar 

  5. Ostrow JD, Timmerman RJ, Gray SJ: Gastric secretion in human hepatic cirrhosis. Gastroenterology 38:303-313, 1960

    Google Scholar 

  6. Lam SK: Hypergastrinaemia in cirrhosis of liver. Gut 17:700-708, 1976

    Google Scholar 

  7. Tsai CJ: Helicobacter pylori infection and peptic ulcer disease in cirrhosis. Dig Dis Sci 43:1219-1225, 1998

    Google Scholar 

  8. Wu CS, Lin CY, Liaw YF: Helicobacter pylori in cirrhotic patients with peptic ulcer disease: a prospective, case controlled study. Gastrointest Endosc 42:424-427, 1995

    Google Scholar 

  9. Chen JJ, Changchien CS, Tai DI, Chiou SS, Lee CM, Kuo CH: Role of Helicobacter pylori in cirrhotic patients with peptic ulcer. A serological study. Dig Dis Sci 39:1565-1568, 1994

    Google Scholar 

  10. Calvet X, Navarro M, Gil M, Mas P, Rivero E, Sanfeliu I, Brullet E, Campo R, Dalmau B, Lafont A: Seroprevalence and epidemiology of Helicobacter pylori infection in patients with cirrhosis. J Hepatol 26:1249-1254, 1997

    Google Scholar 

  11. Pugh RNH, Murray-Lyon IM, Dawson JL: Transection of the oesophagus for bleeding oesophageal varices. Br J Surg 60:646-649, 1973

    Google Scholar 

  12. Lamarque D, Levoir D, Duvoux C, Herigault R, Dutreuil C, Adnot S, Dhumeaux D, Delchier JC: Measurement of gastric intramucosal pH in patients with cirrhosis and portal hypertensive gastropathy. Gastroenterol Clin Biol 18:969-974, 1994

    Google Scholar 

  13. Lotterer E, Ramaker J, Lüdtke FE, Tegeler R, Geletneky JV, Bauer FE: The simplified 13C-urea breath test—one point analysis for detection of Helicobacter pylori infection. Z Gastroenterol 29:590-594, 1991

    Google Scholar 

  14. Zullo A, Rinaldi V, Meddi P, Folino S, Lauria V, Diana F, Winn S, Attili AF: Helicobacter pylori infection in dyspeptic cirrhotic patients. Hepatogastroenterology 46:395-400, 1999

    Google Scholar 

  15. Sacchetti C, Capello M, Rebecchi P, Roncucci L, Zanghieri G, Tripodi A, Ponz de Leon M: Frequency of upper gastrointestinal lesions in patients with liver cirrhosis. Dig Dis Sci 33:1218-1222, 1988

    Google Scholar 

  16. Siringo S, Vaira D, Menegatti M, Piscaglia F, Sofia S, Gaetani M, Miglioli M, Corinaldesi R, Bolondi L: High prevalence of Helicobacter pylori in liver cirrhosis: relationship with clinical and endoscopic features and the risk of peptic ulcer. Dig Dis Sci 42:2024-2030, 1997

    Google Scholar 

  17. Wang CH, Ma LR, Lin RC, Kuo JY, Chang KK: Helicobacter pylori infection and risk of peptic ulcer among cirrhotic patients. J Formos Med Assoc 96:55-58, 1997

    Google Scholar 

  18. Schmulson MJ, De Leon G, Kershenovich A, Vargas-Vorackova F, Kershenobich D: Helicobacter pylori infection among patients with alcoholic and nonalcoholic cirrhosis. Helicobacter 2:149-151, 1997

    Google Scholar 

  19. Bahnacy A, Kupcsulik P, Eles Z, Jaray B, Flautner L: Helicobacter pylori infection in congestive gastropathy. Helicobacter 1:168-171, 1996

    Google Scholar 

  20. Kuipers EJ, Thijs JC, Festen HP: The prevalence of Helicobacter pylori in peptic ulcer disease. Aliment Pharmacol Ther 9(suppl 2):59-69, 1995

    Google Scholar 

  21. Arakawa T, Satoh H, Fukuda T, Nakamura H, Kobayashi K: Endogenous prostaglandin E2 in gastric mucosa of patients with alcoholic cirrhosis and portal hypertension. Gastroenterology 93:135-140, 1987

    Google Scholar 

  22. Fraser AG, Pounder RE, Burroughs AK: Gastric secretion and peptic ulceration in cirrhosis. J Hepatol 19:171-182, 1993

    Google Scholar 

  23. Pointner H: Normal serum gastrin levels in patients with liver cirrhosis. Digestion 13:6, 1975

    Google Scholar 

  24. Aldoori WH, Giovannucci EL, Stampfer MJ, Rimm EB, Wing AL, Willett WC: A prospective study of alcohol, smoking, caffeine, and the risk of duodenal ulcer in men. Epidemiology 8:420-424, 1997

    Google Scholar 

  25. Chou SP: An examination of the alcohol consumption and peptic ulcer association—results of a national survey. Alcohol Clin Exp Res 18:149-153, 1994

    Google Scholar 

  26. Kato I, Nomura AM, Stemmermann GN, Chyou PH: A prospective study of gastric and duodenal ulcer and its relation to smoking, alcohol, and diet. Am J Epidemiol 135:521-530, 1992

    Google Scholar 

  27. Beck PL, Lee SS, McKnight GW, Wallace JL, Lee SS: Characterization of spontaneous and ethanol-induced gastric damage in cirrhotic rats Gastroenterology 103:1048-1055, 1992

    Google Scholar 

  28. Rabinovitz M, Schade RR, Dindzans V, Van Thiel DH, Gavaler JS: Prevalence of duodenal ulcer in cirrhotic males referred for liver transplantation. Does the etiology of cirrhosis make a difference? Dig Dis Sci 35:321-326, 1990

    Google Scholar 

  29. Chow JY, Ma L, Zhu M, Cho CH: The potentiating actions of cigarette smoking on ethanol-induced gastric mucosal damage in rats. Gastroenterology 113:1188-1197, 1997

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Service d'Hépatologie et de Gastroentérologie, Hopital Henri Mondor, AP-HP, Université Paris XII, 51 Avenue du Maréchal De Lattre de Tassigny, F-94010, Créteil, France

    Jean Auroux, Dominique Lamarque, Jean Philippe Richardet & Jean Charles Delchier

  2. Service de Santé publique, Hopital Henri Mondor, AP-HP, Université Paris XII, 51 Avenue du Maréchal De Lattre de Tassigny, F-94010, Créteil, France

    Françoise Roudot-Thoraval

  3. Service de Bactériologie et de Virologie, Hopital Henri Mondor, AP-HP, Université Paris XII, 51 Avenue du Maréchal De Lattre de Tassigny, F-94010, Créteil, France

    Lionel Deforges

  4. Département d'Anatomie Pathologique, Hopital Henri Mondor, AP-HP, Université Paris XII, 51 Avenue du Maréchal De Lattre de Tassigny, F-94010, Créteil, France

    Marie Thérèse Chaumette

Authors
  1. Jean Auroux
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dominique Lamarque
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Françoise Roudot-Thoraval
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lionel Deforges
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Marie Thérèse Chaumette
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jean Philippe Richardet
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jean Charles Delchier
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Auroux, J., Lamarque, D., Roudot-Thoraval, F. et al. Gastroduodenal Ulcer and Erosions Are Related to Portal Hypertensive Gastropathy and Recent Alcohol Intake in Cirrhotic Patients. Dig Dis Sci 48, 1118–1123 (2003). https://doi.org/10.1023/A:1023772930681

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1023/A:1023772930681

  • cirrhosis
  • H. pylori
  • gastroduodenal ulcer
  • portal hypertensive gastropathy