Peptic ulcer bleeding in patients with or without cirrhosis: different diseases but the same prognosis
Alimentary Pharmacology and Therapeutics, 06/01/2012
Rudler M et al. – Physiopathology of peptic ulcer bleeding (PUB) seems to be different in patients with cirrhosis. In cirrhotic patients, PUB occurs almost only in alcoholics. In the series, prognosis was similar to general population. PUB in cirrhosis might be related to portal hypertension and/or alcohol.Methods
- The authors included prospectively all patients with PUB referred to the 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.
- 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).