Gastroduodenal Ulcer in Cirrhotic Patients: Epidemiological, Diagnostic, and Prognostic Aspects at Libreville Teaching Hospital

Abstract

Introduction : The association between peptic ulcer disease (PUD) and cirrhosis is regularly observed in practice but has never been the subject of a scientific publication in Gabon. The aim of our study was to establish the epidemiological, diagnostic, and prognostic aspects of PUD in cirrhotic patients hospitalised at the Libreville Teaching Hospital (CHUL). Patients and Methods: This is a retrospective, descriptive, and comparative bivariate analytical study between two groups (cirrhotic patients with PUD vs. cirrhotic patients without PUD), conducted from January 2023 to December 2024 in the hepatogastroenterology department of the CHUL. All cirrhotic patients who underwent upper digestive endoscopy were included. Clinical, biological, endoscopic, and evolutionary data were collected and analysed. Statistical analysis was performed using SPSS version 25.0 software, and Chi-2 and Student’s t-tests were used for comparison, with a significance threshold of p < 0.05. Results : We included 109 cirrhotic patients divided into two groups, one with PUD (n = 35) and one without PUD (n = 74). The sex ratio was 1.06 vs 1.47. The mean age was 55.03 years ± 17.17 years vs. 48.44 years ± 15.15 years (p = 0.013). Hypertension and diabetes were present in 17.14% vs. 24.32% and 14.29% vs. 12.16% of patients, respectively. Abdominal pain was present in 8.57% vs. 9.46% (p = 0.7813). The location of the peptic ulcer was gastric in 51.43%, duodenal in 40%, and mixed in 3.857% of cases. Ascites, jaundice, and gastrointestinal hemorrhage were observed in 88.57% vs. 77.03%, 45.71% vs. 44.59%, and 40% vs. 44.59% of cases, respectively. Complications of cirrhosis were hemorrhagic shock (40% vs. 29.73%), followed by primary liver cancer (5.71% vs. 14.86%) and spontaneous infection of ascites fluid (5.71% vs. 8.11%). The aetiologies of cirrhosis were alcohol (37.14% vs. 33.78%), viral hepatitis B (31.43% vs. 22.97%), and C (17.14% vs. 12.16%). Stress was the risk factor for PUD that showed a statistical link (p = 0.0106), whereas the search for chronic H . pylori infection did not. In terms of prognosis, PUD was classified as Forrest III in 68.57% of patients, Forrest IIB in 22.86%, and Forrest IIC in 8.57%. Cirrhosis was classified as Child-Pugh A in 20% vs. 28.38% (p = 0.3499), Child-Pugh B in 48.57% vs. 52.70% (p = 0.6870), and Child-Pugh C in 31.43% vs. 18.92% (p = 0.1469). There were 22.86% deaths versus 22.97%. The causes of death were hemorrhagic shock (5 deaths out of 8) versus primary liver cancer (9 deaths out of 17, with p = 0.0128). Conclusion : The association between peptic ulcer disease and cirrhosis is common and affects middle-aged men with comorbidities. The role of H . pylori remains unclear, and the prognosis is worsened by hemorrhagic shock.