Document Detail

Peptic ulcer bleeding in patients with or without cirrhosis: different diseases but the same prognosis?
MedLine Citation:
PMID:  22607536     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Physiopathology and prognosis of peptic ulcer bleeding (PUB) have never been described in cirrhotic patients.
AIM: To assess risk factors and outcome of PUB in two groups of patients with PUB with or without cirrhosis.
METHODS: We included prospectively all patients with PUB referred to our ICU of Hepatology and Gastroenterology between January 2008 and March 2011. All patients were treated according to international recommendations. Diagnosis of cirrhosis was based on clinical, biological and morphological exams. Aetiologies, characteristics and outcomes of PUB were compared in cirrhotic vs. noncirrhotic patients.
RESULTS: A total of 203 patients with PUB were included prospectively. Twenty-nine patients had cirrhosis (group Cirr+), and 174 patients had no cirrhosis (group Cirr-). Demographic data were similar between the two groups except for age and alcohol consumption. Aetiology of cirrhosis was alcohol in 97% of cirrhotic patients. Characteristics of PUB were not different between the two groups. Ninety-three per cent of patients with cirrhosis had endoscopic portal hypertension. Aetiology of PUB was different between the group Cirr+ and Cirr- (Helicobacter pylori = 10.3% vs. 48.8%, P < 0.0001; NSAID's = 17.2% vs. 54.0%, P < 0.0001; idiopathic PUB = 79.3% vs. 23.8%, P < 0.0001). Outcome was comparable concerning re-bleeding (7.0% vs. 6.9%, P = 0.31), need for arterial embolisation (10.3 vs. 8.6%, P = 0.76), need for salvage surgery (0 vs. 1.7%, P = 0.31) and mortality (3.0% vs. 1.1%, P = 0.87).
CONCLUSIONS: Physiopathology of PUB seems to be different in patients with cirrhosis. In cirrhotic patients, PUB occurs almost only in alcoholics. In our series, prognosis was similar to general population. PUB in cirrhosis might be related to portal hypertension and/or alcohol.
M Rudler; G Rousseau; H Benosman; J Massard; L Deforges; P Lebray; T Poynard; D Thabut
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Publication Detail:
Type:  Journal Article     Date:  2012-05-20
Journal Detail:
Title:  Alimentary pharmacology & therapeutics     Volume:  36     ISSN:  1365-2036     ISO Abbreviation:  Aliment. Pharmacol. Ther.     Publication Date:  2012 Jul 
Date Detail:
Created Date:  2012-06-18     Completed Date:  2012-11-01     Revised Date:  2013-02-12    
Medline Journal Info:
Nlm Unique ID:  8707234     Medline TA:  Aliment Pharmacol Ther     Country:  England    
Other Details:
Languages:  eng     Pagination:  166-72     Citation Subset:  IM    
Copyright Information:
© 2012 Blackwell Publishing Ltd.
Department of Hepatogastroenterology, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie University, France.
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MeSH Terms
Alcohol Drinking / adverse effects*
Anti-Inflammatory Agents, Non-Steroidal / adverse effects*
Helicobacter Infections / complications*
Helicobacter pylori / isolation & purification
Liver Cirrhosis / complications*,  drug therapy,  physiopathology
Middle Aged
Peptic Ulcer Hemorrhage / drug therapy,  etiology*,  physiopathology
Prospective Studies
Risk Factors
Reg. No./Substance:
0/Anti-Inflammatory Agents, Non-Steroidal
Comment In:
Aliment Pharmacol Ther. 2012 Sep;36(6):597-8; author reply 598   [PMID:  22913844 ]
Aliment Pharmacol Ther. 2013 Feb;37(3):369-70   [PMID:  23281729 ]
Aliment Pharmacol Ther. 2013 Feb;37(3):368-9   [PMID:  23281728 ]

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