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Combined upper and lower gastrointestinal endoscopy: a prospective study in alcoholic and nonalcoholic cirrhosis
M Rabinovitz1, S Kumar, M Kajani
1Division of Gastroenterology, Graduate School of Public Health, University of Pittsburgh, Pennsylvania 15261.
Insights
Cirrhosis patients undergoing evaluation for liver transplantation showed varying gastrointestinal bleeding risks. Alcoholic cirrhosis patients had higher rates of gastritis and ulcers compared to non-alcoholic cases.
Area of Science:
- Gastroenterology
- Hepatology
- Endoscopy
Background:
- Upper gastrointestinal hemorrhage is a significant complication of cirrhosis.
- Existing data on bleeding sites in cirrhosis primarily focuses on alcoholic cases during acute bleeding episodes.
- Limited information exists on endoscopic findings in stable cirrhotic patients of any etiology.
Purpose of the Study:
- To determine the prevalence of upper and lower gastrointestinal lesions in hemodynamically stable cirrhotic patients undergoing evaluation for liver transplantation.
- To compare the prevalence of these lesions between alcoholic and non-alcoholic cirrhosis.
- To investigate the association between portal hypertension and gastrointestinal lesions in different cirrhosis etiologies.
Main Methods:
- A study of 510 cirrhotic subjects evaluated for liver transplantation (OLTx) between 1985 and 1987.
- 412 patients underwent combined upper and lower gastrointestinal endoscopy; 98 had upper endoscopy only.
- Patients were categorized into alcoholic (n=75) and non-alcoholic (n=435) cirrhosis groups.
Main Results:
- Gastritis, gastric ulcer, and duodenal ulcer disease were significantly more common in alcoholic cirrhosis patients (p<0.025).
- Lower gastrointestinal lesion prevalence was similar between alcoholic and non-alcoholic cirrhosis groups.
- In alcoholic cirrhosis, lesion prevalence was unrelated to portal hypertension; in non-alcoholic cirrhosis, gastritis and duodenal ulcers correlated with portal hypertension indicators (varices, ascites, encephalopathy).
Conclusions:
- Alcoholic cirrhosis is associated with a higher prevalence of specific upper gastrointestinal lesions compared to non-alcoholic cirrhosis.
- The relationship between portal hypertension and gastrointestinal lesions differs based on the etiology of cirrhosis.
- Endoscopic evaluation is crucial for assessing gastrointestinal complications in cirrhotic patients, irrespective of etiology or bleeding status.
Abstract:
Upper gastrointestinal hemorrhage is one of the more important complications of cirrhosis. Most of the available data regarding the prevalence of upper and lower gastrointestinal sites of bleeding in cirrhotic patients have been obtained in individuals with alcoholic cirrhosis evaluated in the course of an acute gastrointestinal bleeding episode. Few data exist, however, as to the prevalence of either potential bleeding sites or of normal endoscopic findings in hemodynamically stable individuals with cirrhosis of any etiology. Five hundred ten cirrhotic subjects, who were evaluated for possible liver transplantation (OLTx) between January 1985 and June 1987, were included in this study. Seventy-five had alcoholic cirrhosis and 435 had nonalcoholic cirrhosis of various etiologies. Of these 510 patients, 412 underwent combined upper and lower gastrointestinal endoscopy and 98 underwent upper gastrointestinal endoscopy alone. Gastritis, gastric and duodenal ulcer disease were found significantly (each at least p less than 0.025) more often in patients with alcoholic liver disease than in those with nonalcoholic liver disease. The prevalence of the various lower gastrointestinal lesions in both groups was similar. Of particular interest is the fact that in alcoholic cirrhotics, the prevalence of gastritis, gastric ulcer and duodenal ulcer disease was unrelated to the degree of portal hypertension, whereas in the nonalcoholic cirrhotics the prevalence of gastritis and duodenal ulcer disease but not gastric ulcer disease was associated significantly with the degree of portal hypertension as assessed by the presence or absence of large esophageal varices, ascites, and hepatic encephalopathy.