DUODENAL EROSIONS AND ULCERS IN PATIENTS WITH PANCREATICOBILIARY OBSTRUCTION

In order to determine whether obstructive pancreatobiliary lesions inc rease the risk of duodenal erosions and ulcers, the duodenal mucosa of patients with these lesions were prospectively examined before endosc opic retrograde cholangiopancreatography (ERCP). During the study peri od, 133 patients underwent ERCP for various reasons in the Department of Medicine, The Aga Khan University Hospital. One hundred and twenty- three patients were eligible for final analysis. Sixty-five patients w ith bilirubin greater than or equal to 35 mu mol/L and alkaline phosph atase greater than or equal to 2.5 times normal levels along with radi ological evidence of pancreatobiliary obstruction were included in the obstruction group. Fifty-eight patients who did not fulfil these crit eria were used in the control group. Acid peptic lesions, which includ ed erosions and ulcers, were seen in 16 patients of the obstruction gr oup and four patients of the control group (P = 0.016, odds ratio (OR) = 4.41). Patients with carcinoma of the pancreas had a greater number of lesions than the rest of the obstruction group (P = 0.001, OR = 8. 75). Individual variables like age, sex, serum bilirubin, alanine amin otransferase, alkaline phosphatase, amylase levels, and duration of ja undice did not increase the vulnerability to acid peptic injury. The d egree of obstruction multiplied by duration of jaundice (alkaline phos phatase x days) increased the susceptibility for duodenal disease (P = 0.047). From this data it was concluded that patients with obstructiv e pancreatobiliary lesions are more prone to acid peptic duodenal lesi ons.