1976 Volume 73 Issue 5 Pages 544-553
It is said that peptic ulcer is frequently combined with liver cirrhosis. But reason for this phenomenon remains unexplained in spite of many theories. To explore it, we studied 91 cirrhotic patients diagnosed by laparoscopy with histological confirmation or autopsy from Jan. 1968 to Dec. 1973.
All of these patients were examined thier upper gastrointestinal tract endoscopically, and peptic ulcer was found in 13 patients (14.3%). These included 7 chronic gastric ulcers, 2 duodenal ulcers, 2 gastric and duodenal ulcers, and 2 acute gastric ulcers. Characters of these ulcers were almost the same as ordinary ulcers uncombined with liver cirrhosis.
To investigate causes of ulcers in cirrhotic patients, we studied acidity of gastric juice, serum gastrin level, grade of esophageal varices and splenomegaly, and pressure of the rectal veins. As in the gastric acidity, patients with ulcer had a tendency to be only slightly higher gastric acidity than those without ulcer, while almost all patients showed normoacidity. Serum gastrin level in ulcer patients was almost the same as in patients without ulcer. Grade of esophageal varices, splenomegaly and rectal venous pressure which we adopted as the indicators of severity of portal hypertention were not so different between ulcer and nonulcer groups. There was no great difference in the presence of history of acute hepatitis, blood transfusion and grade of alcohol intake between both group. As for the relation to the patterns of liver cirrhosis, we could not obtain any clear result because it was very difficult to classify the patterns of liver cirrhosis only with laparoscopy and liver biopsy, and there were only few cases of autopsy in this series.
Healing course of peptic ulcer is relatively rapid, on the contrary, liver cirrhosis has a slow and progressive course. We could not find out any significant relationship between healing or recurrence of gastric ulcer and the activity of liver cirrhosis in this small series.
Massive upper GI bleeding occured in 25 cases in our series (28.6%). The sources of bleeding were 3 gastric ulcers, 2 duodenal ulcers and 2 esophageal varices in ulcer group, on the contrary, all those of the other 18 patients were from esophageal varices in non-ulcer group.