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[Gastrointestinal lesions in liver cirrhosis]
Y Fujiwara1, T Arakawa, K Higuchi
13rd Department of Internal Medicine, Osaka City University Medical School.
Insights
Gastrointestinal bleeding in liver cirrhosis patients stems from reduced gastric mucosal defense, particularly prostaglandins. Helicobacter pylori infection shows no clear link to these lesions in cirrhosis.
Area of Science:
- Gastroenterology
- Hepatology
- Pathophysiology
Context:
- Liver cirrhosis frequently causes gastrointestinal (GI) bleeding.
- Esophageal and gastric varices, gastroduodenal ulcers, and congestive gastropathy are common GI lesions.
- Portal hypertension is the primary driver of these GI lesions.
Purpose:
- To review gastric mucosal defense mechanisms and Helicobacter pylori infection in liver cirrhosis.
- To explore the role of reduced gastric mucosal defense in GI bleeding associated with liver cirrhosis.
Summary:
- Gastric mucosal defense is impaired in liver cirrhosis, with decreased levels of protective prostaglandins.
- Despite the known association of Helicobacter pylori with peptic ulcer disease, studies show no consistent link between H. pylori infection and gastroduodenal ulcers or congestive gastropathy in cirrhosis.
- Reduced gastric mucosal defense mechanisms are implicated as a key factor in the pathogenesis of GI lesions in liver cirrhosis.
Impact:
- Highlights the critical role of impaired gastric mucosal defense in GI bleeding in liver cirrhosis.
- Suggests that H. pylori infection may not be a primary contributor to GI lesions in this patient population.
- Provides insights for understanding and potentially managing GI complications in liver cirrhosis.
Abstract:
The gastrointestinal bleeding commonly observed in patients with liver cirrhosis is usually from esophageal and gastric varices, gastroduodenal ulcer, and congestive gastropathy. Portal hypertension is the major causative factor of pathogenesis of GI lesions. In the present review, we focus in gastric mucosal defense and Helicobacter pylori infection in liver cirrhosis. Gastric mucosal defense is reduced in liver cirrhosis, especially prostaglandins which play a role in the gastric mucosal defense decreased in the gastric mucosal of patients with liver cirrhosis and rat portal hypertension model. Although H. pylori is strongly associated with peptic ulcer disease and chronic gastritis, several studies showed no relationship between H. pylori infection and gastroduodenal ulcer or the infection and congestive gastropathy in liver cirrhosis. Reduced gastric mucosal defense may account for the pathogenesis of GI lesions in liver cirrhosis.