Prevalence and pathogenesis of duodenal ulcer in chronic alcoholic pancreatitis.
BACKGROUND
The prevalence of duodenal ulcer (DU) has been considered high in patients with chronic pancreatitis; however, its pathogenesis is unclear. We hypothesized that Helicobacter pylori infection plays the major pathogenetic role.


METHODS
One hundred seven cases (97 men, 10 women) of chronic alcoholic pancreatitis (CAP) were prospectively investigated from 1997 to 2001. One hundred thirty-seven DU patients and 59 nonulcer dyspepsia patients formed the two control groups. Pancreatic function was evaluated by determination of fecal fat excretion and fasting blood glucose concentration. Upper gastrointestinal endoscopy was performed in all patients, and gastric mucosal biopsies were taken for assessment of H. pylori infection with a modified Giemsa stain and rapid urease test.


RESULTS
Fifteen (14%) of the 107 patients with CAP had active DU. There was a trend toward an association between the presence of diabetes mellitus and/or steatorrhea and the occurrence of DU in patients with CAP (p = 0.06). The rate of H. pylori infection was significantly higher in patients with CAP and DU than in those with only CAP (86.7% vs. 54.3%, p = 0.02) but the rate similar to that in patients with simple DU (75.2%). Trends toward higher prevalence of H. pylori infection in CAP with DU were noticed when they were compared with the nonulcer dyspepsia group (86.7% vs. 66.1%). There was no significant difference in prevalence of H. pylori between CAP patients without DU and dyspeptic patients (54.3% vs. 66.1%).


CONCLUSIONS
These data demonstrate that the prevalence of DU in CAP is relatively high. H. pylori infection seems to play the major pathogenetic role in DU associated with CAP.
Chebli
Julio Maria Fonseca
JM
Division of Gastroenterology, Department of Internal Medicine, Federal University of Juiz de Fora-Minas Gerais, Brazil. chebli@hu.ufjf.br
de Souza
Aécio Flávio Meirelles
AF
Gaburri
Pedro Duarte
PD
Bastos
Kátia Valeria
KV
Ribeiro
Tarsila Campanha Rocha
TC
Filho
Roberto José Carvalho
RJ
Chebli
Liliana Andrade
LA
Castro Ferreira
Lincoln Eduardo V V
LE
D000328:Adult; D000368:Aged; D002908:Chronic Disease; D015897:Comorbidity; D004381:Duodenal Ulcer / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D016481:Helicobacter Infections / Q000150:complications; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D019512:Pancreatitis, Alcoholic / Q000453:epidemiology*; D015995:Prevalence; D011446:Prospective Studies