Gastrointestinal mucosal lesions in patients with acute pancreatitis

Gastrointestinal mucosal lesion is frequently associated with major systemic disease, but its role in acute pancreatitis is rarely discussed. The aim of this study was to evaluate the incidence of ulcer formation of upper gastrointestinal (UGI) tract in patients with acute pancreatitis.

From May 1999 to April 2000, a total of 87 patients with acute pancreatitis who had received UGI endoscopy during hospitalization were included. Acute pancreatitis was diagnosed by typical epigastric pain with hyperamylasemia (> three times upper normal limit), hyperlipasemia, or abnormal finding of pancreas over abdominal sonography or computed tomography (CT). CT finding of acute pancreatitis was graded from A to E according to the system of Balthazar et al. According to the endoscopic findings, patients were subdivided into non-ulcer (normal and gastritis) and ulcer groups (esophageal, gastric, and/or duodenal ulcers). The correlations between the clinical features, CT grading, and endoscopic findings were analyzed.

Of the 87 patients, 61 patients were male and 26 were female. The mean age was 55.1 +/- 18 years (range 19-87 years). The etiologies of pancreatitis include: gallstones (46), alcohol (20), hyperlipidemia (9) and idiopathic (12). Forty-six patients (52.9%) were found having ulcers by endoscopy (15 patients had previous ulcer history). The location of ulcers included esophagus (8), stomach (17) and duodenum (21). The incidence of ulcers was more frequent in patients with severe pancreatitis according to CT grading (A+B vs. C+D+E, p = 0.03). There was no statistical significance in relationship between ulcer formation and sex, age, etiologies, Ranson's score or clinical symptoms.

More than half of patients with acute pancreatitis may complicate with upper gastrointestinal ulcers. The occurrence of ulcer was positively correlated with the severity of pancreatitis.