Peptic ulcer and gastric secretion in patients with liver disease. Gut

SYNOPSIS The overall incidence of peptic ulcer in 290 patients with portal cirrhosis was 113 %. The incidence was the same in male and female patients whether or not the patient had an alcoholic history and whether or not they had had a portacaval anastomosis. No abnormality of gastric secretion was observed in patients with hepatic cirrhosis except after a portacaval anastomosis when the basal gastric acid secretion increases, but there is no concomitant increase in response to maximum histamine stimulation. In addition the gastric contents both at night when fasting and during the day on a standardized diet were more acid in patients who had undergone a portacaval anastomosis than in patients with uncomplicated hepatic cirrhosis. Patients with hepatic cirrhosis may bleed into the gut not only from oesophageal varices, but also from a chronic peptic ulcer or erosive gastritis (Palmer and Brick, 1953). It may thus be difficult to pinpoint the exact cause of gastrointestinal haemor-rhage in patients with hepatic cirrhosis, especially as it is generally agreed that there is a high incidence of peptic ulcer in such patients. But the reported frequency of this association varies widely (Koide, Texter, and Borden, 1958) and most of the series have been reported from North America where cirrhosis is usually associated with alcoholism so that it is often not clear whether the important factor is the liver disease or the alcoholism. More recently it has been suggested that ulcers occur even more frequently following a portacaval anastomosis opera-tion (Clarke, Ozeran, Hart, Gruze, and Crevling, 1958). This has stimulated the re-investigation of the effects of such operations on gastric secretion in dogs and it has been confirmed that following such an operation the acid secretion from a Heidenhain pouch is greatly increased (Clarke et al., 1958); but the results of gastric secretory studies in patients with hepatic cirrhosis have been conflicting (Ostrow