Does portal hypertension contribute to the pathogenesis of gastric ulcer associated with liver cirrhosis?

Abstract

The prevalence of gastric ulcers in patients with liver cirrhosis is increased compared with that in the general population, and portal hypertension may contribute to the increased risk of gastric ulcer in cirrhosis patients. Aggressive factors involved in the pathogenesis of gastric ulcer are diminished in association with portal hypertension. In contrast, most of the important gastric mucosal defense mechanisms are shown to be impaired in portal hypertension; many of these mechanisms are also found to be altered in patients with liver cirrhosis. Portal hypotensive treatment with propranolol reduces ethanol-induced gastric mucosal damage in portal hypertensive rats and improves endoscopic signs of portal hypertensive gastropathy in cirrhosis patients. Together, these findings suggest portal hypertension-induced impairment of the gastric mucosal defenses to be an important factor in the pathogenesis of gastric ulcer in patients with liver cirrhosis. Prospective studies of portal pressure-reducing procedures, such as pharmacotherapy with propranolol, and their effect on the incidence of gastric ulcer in cirrhosis patients are needed to confirm this suggestion.

Gastric Tissue Oxidative Changes in Portal Hypertension and Cirrhosis

“…However, the role of portal hypertension in the pathogenesis of gastric ulcer is poorly understood [10]. There is an increased prevalence of gastric ulcer in cirrhosis patients according to study data [10]. Tomoda et al reported not only a high prevalence of gastric ulcer (20%) but also a very high prevalence of gastric erosions in cirrhosis patients (44%) [11].…”

“…Liver cirrhosis is often associated with portal hypertension, which has been proven to affect many gastric functions and to weaken gastric mucosal defense. However, the role of portal hypertension in the pathogenesis of gastric ulcer is poorly understood [10]. There is an increased prevalence of gastric ulcer in cirrhosis patients according to study data [10].…”

SBRT: A viable option for treating adrenal gland metastases

“…An accurate baseline evaluation of patients' history should be undertaken prior to treatment, as some studies have shown that a history of gastro-duodenal ulcer is a significant risk factor for ulceration after conventional RT 38 and SBRT 39 and recommend that these patients be treated with considerable caution. Moreover, some clinical conditions such as portal hypertension cause functional abnormalities in the gastric mucosa and reduce the defensive and healing mechanism, 40 thus leading to an increased risk of gastrointestinal toxicity.…”

Assessment of Bleeding Risk in Patients with Cirrhosis

“…The main cause of gastrointestinal non-variceal bleeding, peptic ulcer disease, is more prevalent in cirrhosis patients than in the general population [41,42], and while in the latter Helicobacter pylori infection constitutes the main cause, its role is less important in cirrhosis, illustrating the unknown mechanisms that lead to ulcer formation and to ulcer bleeding in cirrhosis [41,[43][44][45]. In the nationwide US study by Venkatesh and collaborators analyzing peptic ulcer bleeding in over 3500 patients with cirrhosis, although not further described, Bcoagulopathy^was present in 18.7, and the percentage reached 24.8 % in decompensated cirrhosis [39].…”