Frequency of Duodenal Ulcer in Cirrhosis of Liver

Introduction: Cirrhosis of the liver is a common cause of duodenal ulcer. Liver cirrhosis results in portal hypertension, splenomegaly, esophageal varices (EV) and duodenal ulcers. Duodenal ulcer bleeding is a serious complication with significant morbidity and mortality. It has therefore been recommended that patients with liver cirrhosis should be screened for the presence of duodenal ulcer at the time of initial diagnosis, and at periodic intervals thereafter throughout life. Duodenal ulcer can cause fatal hemorrhage in patients of cirrhosis, thus emphasizing need for surveillance of duodenal ulcer as the cause of bleeding rather than esophageal varices. This study is to see the association of duodenal ulcer in cirrhotic patients presenting in Medical Unit 1. The application of its results may help in early management of life threatening upper gastrointestinal hemorrhage. Objective: To determine the frequency of duodenal ulcers among patients of liver cirrhosis. Study Design: Cross sectional survey. Setting: Medical Unit 1, Services Hospital, Lahore. Duration with dates: The study was completed over a period of 6 months; from 20th November 2008 to 19th May 2009. Subjects and Methods: Hundred and thirty five patients who had coarse echotexture of liver on abdominal ultrasound, and fulfilling the inclusion criteria were enrolled in the study. These patients were then subjected to upper gastrointestinal endoscopy after informed consent and the presence and number of duodenal ulcers were noticed. Also noticed was site, size of ulcer and whether the ulcer was bleeding or not. Results: The frequency of duodenal ulcers in patients of liver cirrhosis was 9.6%. Conclusion: The study showed that duodenal ulcer was present in 9.6% patients of liver cirrhosis. Its application will help in identifying the cause of bleeding in cirrhotic patients while performing upper gastrointestinal endoscopy and will help in management.