Skip to main content

Advertisement

SpringerLink
Log in

Prevalence of duodenal ulcer in cirrhotic males referred for liver transplantation

Does the etiology of cirrhosis make a difference?

  • Original Articles
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

The prevalence of symptomatic duodenal ulcer (DU) assessed primarily in alcoholic males with cirrhosis is estimated to be approximately fivefold increased compared to the normal population. Little information is available, however, as to the prevalence of DU in nonbleeding, nonalcoholic subjects with cirrhosis. In order to estimate the prevalence of DU in males with various types of cirrhosis and its relation to the degree of portal hypertension, 216 male cirrhotic patients (165 with parenchymal liver disease and 51 with cholestatic liver disease) being evaluated for liver transplantation at the University of Pittsburgh between January 1985 and June 1987 underwent pan-upper gastrointestinal endoscopy. The prevalence of DU in each group was 7.8%. However, among the various subgroups it was as follows: chronic active hepatitis due to HBV: 9.4%, alcoholic: 12.2%, cryptogenic: 3.5%, autoimmune chronic active hepatitis: 6.6%, primary sclerosing cholangitis (PSC): 9.5%. The reference data for this study consist of data reported in the literature obtained in 355 healthy asymptomatic male volunteers. The prevalence of DU in this group is significantly less than in the study group (2.2% vs 7.8%; P<0.005). While the estimated risk for a DU is increased 3.71-fold (95% CI: 8.74, 1.57; P<0.005) in cirrhotic males in general as compared to normal males, only the subgroups with CAH due to HBV, alcoholism, and PSC were found to have an increased estimated risk of DU (all at least P<0.01). No association between the prevalence of DU and degree of portal hypertension could be demonstrated in either group.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

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

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Conn HO, Atterbury CE: Cirrhosis.In: Diseases of the Liver, 6th ed. L Schiff, ER Schiff (eds). Philadelphia, JB Lippincott, 1987, p 753

    Google Scholar 

  2. Phillips MM, Ramsby GR, Conn HO: Portocaval anastomosis and peptic ulcer: A nonassociation. Gastroenterology 68:121–131, 1975

    PubMed  Google Scholar 

  3. Lipp WF, Lipsitz MH: The clinical significance of the coexistence of peptic ulcer and portal cirrhosis, with special reference to the problem of massive hemorrhage. Gastroenterology 22:181–191, 1952

    PubMed  Google Scholar 

  4. Palmer ED, Brick IB: Sources of upper gastrointestinal hemorrhage in cirrhotic patients with esophageal varices. N Engl J Med 248:1057–1058, 1953

    PubMed  Google Scholar 

  5. Swisher WP, Baker LA, Bennett HD: Peptic ulcer in Laennec's cirrhosis. Am J Dig Dis 22:291–294, 1955

    PubMed  Google Scholar 

  6. McCray RS, Martin F, Amir-Ahmadi H, Sheahan DG, Zamcheck N: Erroneous diagnosis of hemorrhage from esophageal varices. Am J Dig Dis 14:755–760, 1969

    PubMed  Google Scholar 

  7. Dagradi AE, Mehler R, Tan DTD, Stempien SJ: Sources of upper gastrointestinal bleeding in patients with liver cirrhosis and large esophagogastric varices. Am J Gastroenterol 54:458–463, 1970

    PubMed  Google Scholar 

  8. Thomas E, Rosenthal WS, Rymer W, Katz D: Upper gastrointestinal hemorrhage in patients with alcoholic liver disease and esophageal varices. Am J Gastroenterol 72:623–629, 1979

    PubMed  Google Scholar 

  9. Pugh RNH, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R: Transection of the esophagus for bleeding esophageal varices. Br J Surg 60:646–649, 1973

    PubMed  Google Scholar 

  10. Akdamar K, Ertan A, Agrawal NM, McMahon FG, Ryan J: Upper gastrointestinal endoscopy in normal asymptomatic volunteers. Gastrointest Endosc 32:78–80, 1986

    PubMed  Google Scholar 

  11. Staritz M, Poralla T, Meyer Zum Buschenfelde K-H: Intravascular oesophageal variceal pressure (IOVP) assessed by endoscopic fine needle puncture under basal conditions, Valsalva's manoeuvre and after glyceryltrinitrate application. Gut 26:525–530, 1985

    PubMed  Google Scholar 

  12. Rigau J, Bosch J, Bordas JM, Navasa M, Mastai R, Kravetz D, Bruix J, Feu F, Rodes J: Endoscopic measurement of variceal pressure in cirrhosis: Correlation with portal pressure and variceal hemorrhage. Gastroenterology 96:873–880, 1989

    PubMed  Google Scholar 

  13. Zieve L: Hepatic encephalopathy.In: Diseases of the Liver, 5th ed. Philadelphia, L Schiff, ER Schiff (eds). JB Lippincott, 1982, p 449

    Google Scholar 

  14. Rohlf FJ, Sokal RR: Statistical Tables San Francisco, WH Freeman, 1969, pp 208–214

  15. Fleiss J: Statistical Methods for Rates and Proportions, 2nd ed. New York, John Wiley & Sons, 1981, pp 58–75

    Google Scholar 

  16. Speizer FE, Trey C, Parker P: The uses of multiple causes of death data to clarify changing patterns of cirrhosis mortality in Massachusetts. Am J Public Health 67:333–336, 1977

    PubMed  Google Scholar 

  17. Garceau AJ, Boston Inter-Hospital Liver Group: The natural history of cirrhosis. II. The influence of alcohol and prior hepatitis on pathology and prognosis. N Engl J Med 271:1173–1179, 1964

    PubMed  Google Scholar 

  18. Waldram R, Davis M, Nunnerley H, Williams R: Emergency endoscopy after gastrointestinal hemorrhage in 50 patients with portal hypertension. Br Med J 4:94–96, 1974

    PubMed  Google Scholar 

  19. Palmer ED: The vigorous diagnostic approach to upper gastrointestinal tract hemorrhage. A 23-year prospective study of 1400 patients. JAMA 207:1477–1480, 1969

    PubMed  Google Scholar 

  20. Novis BH, Duys P, Barbezat GO, Clain J, Bank S, Terblanche J: Fibreoptic endoscopy and the use of the Sengstaken tube in acute gastrointestinal hemorrhage in patients with portal hypertension and varices. Gut 17:258–263, 1976

    PubMed  Google Scholar 

  21. Terblanche J, Northover JMA, Bornman P, Kahn D, Silber W, Barbezat GO, Sellars S, Campbell JAH, Saunders SJ: A prospective controlled trial of sclerotherapy in the long term management of patients after esophageal variceal bleeding. Surg Gynecol Obstet 148:323–333, 1979

    PubMed  Google Scholar 

  22. Koff RS: Benefit of endoscopy in upper gastrointestinal bleeding in patients with liver disease. Dig Dis Sci 26:12–16, 1981

    Google Scholar 

  23. Tabaqchali S, Dawson AM: Peptic ulcer and gastric secretion in patients with liver disease. Gut 5:417–421, 1964

    Google Scholar 

  24. Sutton FM: Upper gastrointestinal bleeding in patients with esophageal varices. What is the most common source? Am J Med 83:273–275, 1987

    PubMed  Google Scholar 

  25. Kirk AP, Dooley JS, Hunt RH: Peptic ulceration in patients with chronic liver disease. Dig Dis Sci 25:756–760, 1980

    PubMed  Google Scholar 

  26. Langman MJS, Cooke AR: Gastric and duodenal ulcer and their associated diseases. Lancet 2:680–683, 1976

    Google Scholar 

  27. McCormack TT, Sims J, Eyre-Brook I, Kennedy H, Goepel J, Johnson AG, Triger DR: Gastric lesions in portal hypertension: inflammatory gastritis or congestive gastropathy? Gut 26:1226–1232, 1985

    PubMed  Google Scholar 

  28. Sarfeh IJ, Tarnawski A, Malki A, Mason GR, Mach T, Ivey KJ: Portal hypertension and gastric mucosal injury in rats. Effects of alcohol. Gastroenterology 84:987–993, 1983

    PubMed  Google Scholar 

  29. Lam SK. Hypergastrinemia in cirrhosis of the liver. Gut 17:700–708, 1976

    PubMed  Google Scholar 

  30. Quintero E, Pique JM, Bombi JA, Bordas TM, Sentis J, Elena M, Bosch J, Rodes J: Gastric mucosal vascular ectasias causing bleeding in cirrhosis. A distinct entity associated with hypergastrinemia and low serum levels of pepsinogen I. Gastroenterology 93:1054–1061, 1987

    PubMed  Google Scholar 

  31. Lauritsen KB, Rehfeld JF, Christiansen A, Juhl E, Stadil F: Serum gastrin in cirrhosis. Scand J Gastroenterol 37:33–34, 1976

    Google Scholar 

  32. Strunz UT, Thompson MR, Elashoff J, Grossman MI: Hepatic inactivation of gastrins of various chain lengths in dogs. Gastroenterology 74:550–553, 1978

    PubMed  Google Scholar 

  33. Piper DW, Nasiry R, McIntosh J, Shy CM, Pierce J, Byth K: Smoking, alcohol, analgesic, and chronic duodenal ulcer. A controlled study of habits before first symptoms and before diagnosis. Scand J Gastroenterol 19:1015–1021, 1984

    PubMed  Google Scholar 

  34. Rudert CS, Galambos JT: Alcohol-related symptoms. Clin Gastroenterol 14:575–589, 1985

    PubMed  Google Scholar 

  35. Paffenbarger RS, Wing AL, Hyde RT: Chronic disease in former college students. XII. Early precursors of peptic ulcer. Am J Epidemiol 100:307–315, 1974

    PubMed  Google Scholar 

  36. Friedman GD, Siegelaub A, Seltzer CC: Cigarettes, alcohol, coffee and peptic ulcer. N Engl J Med 290:469–473, 1974

    PubMed  Google Scholar 

  37. Ostensen H, Gudmundsen TE, Ostensen M, Burhol PG, Bonnevie O: Smoking, alcohol, coffee, and familial factors: Any association with peptic ulcer disease? A clinically and radiologically prospective study. Scand J Gastroenterol 20:1227–1235, 1985

    PubMed  Google Scholar 

  38. Sherlock S: Primary biliary cirrhosis (chronic intrahepatic obstruction jaundice). Gastroenterology 37:575–586, 1959

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Gastroenterology Department of Medicine, School of Medicine, University of Pittsburgh, 15261, Pittsburgh, Pennsylvania

    Mordechai Rabinovitz MD, Robert R. Schade MD, Vincents Dindzans MD, David H. Van Thiel MD & Judith S. Gavaler PhD

  2. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 15261, Pittsburgh, Pennsylvania

    Mordechai Rabinovitz MD, Robert R. Schade MD, Vincents Dindzans MD, David H. Van Thiel MD & Judith S. Gavaler PhD

Authors
  1. Mordechai Rabinovitz MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Robert R. Schade MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Vincents Dindzans MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. David H. Van Thiel MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Judith S. Gavaler PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

This work was supported in part by grants from NIDDK (DK32556) and from NIAAA (A06601).

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rabinovitz, M., Schade, R.R., Dindzans, V. et al. Prevalence of duodenal ulcer in cirrhotic males referred for liver transplantation. Digest Dis Sci 35, 321–326 (1990). https://doi.org/10.1007/BF01537409

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01537409

Key words

Search

Navigation