title: Peptic ulcer bleeding in patients with or without cirrhosis: different diseases but the same prognosis?
abstract: BACKGROUND
  Physiopathology and prognosis of peptic ulcer bleeding (PUB) have never been described in cirrhotic patients.
  
  
  OBJECTIVE
  To assess risk factors and outcome of PUB in two groups of patients with PUB with or without cirrhosis.
  
  
  METHODS
  We included prospectively all patients with PUB referred to our ICU of Hepatology and Gastroenterology between January 2008 and March 2011. All patients were treated according to international recommendations. Diagnosis of cirrhosis was based on clinical, biological and morphological exams. Aetiologies, characteristics and outcomes of PUB were compared in cirrhotic vs. noncirrhotic patients.
  
  
  RESULTS
  A total of 203 patients with PUB were included prospectively. Twenty-nine patients had cirrhosis (group Cirr+), and 174 patients had no cirrhosis (group Cirr-). Demographic data were similar between the two groups except for age and alcohol consumption. Aetiology of cirrhosis was alcohol in 97% of cirrhotic patients. Characteristics of PUB were not different between the two groups. Ninety-three per cent of patients with cirrhosis had endoscopic portal hypertension. Aetiology of PUB was different between the group Cirr+ and Cirr- (Helicobacter pylori = 10.3% vs. 48.8%, P < 0.0001; NSAID's = 17.2% vs. 54.0%, P < 0.0001; idiopathic PUB = 79.3% vs. 23.8%, P < 0.0001). Outcome was comparable concerning re-bleeding (7.0% vs. 6.9%, P = 0.31), need for arterial embolisation (10.3 vs. 8.6%, P = 0.76), need for salvage surgery (0 vs. 1.7%, P = 0.31) and mortality (3.0% vs. 1.1%, P = 0.87).
  
  
  CONCLUSIONS
  Physiopathology of PUB seems to be different in patients with cirrhosis. In cirrhotic patients, PUB occurs almost only in alcoholics. In our series, prognosis was similar to general population. PUB in cirrhosis might be related to portal hypertension and/or alcohol.
authors.affiliation: Department of Hepatogastroenterology, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Pierre et Marie Curie University, France. marika.rudler@psl.aphp.fr
authors.forename: M
authors.initials: M
authors.lastname: Rudler
authors.forename: G
authors.initials: G
authors.lastname: Rousseau
authors.forename: H
authors.initials: H
authors.lastname: Benosman
authors.forename: J
authors.initials: J
authors.lastname: Massard
authors.forename: L
authors.initials: L
authors.lastname: Deforges
authors.forename: P
authors.initials: P
authors.lastname: Lebray
authors.forename: T
authors.initials: T
authors.lastname: Poynard
authors.forename: D
authors.initials: D
authors.lastname: Thabut
mesh_terms: D000428:Alcohol Drinking / Q000009:adverse effects*; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D005260:Female; D016481:Helicobacter Infections / Q000150:complications*; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010438:Peptic Ulcer Hemorrhage / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal