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Peptic ulcer bleeding in patients with or without cirrhosis: different diseases but the same prognosis?
Author(s) -
Rudler M.,
Rousseau G.,
Benosman H.,
Massard J.,
Deforges L.,
Lebray P.,
Poynard T.,
Thabut D.
Publication year - 2012
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.2012.05140.x
Subject(s) - medicine , cirrhosis , etiology , gastroenterology , portal hypertension , surgery
Summary 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 H epatology and G astroenterology between J anuary 2008 and M arch 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 C irr+), and 174 patients had no cirrhosis (group C irr−). 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 C irr+ and C irr− ( H elicobacter 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.