Peptic Ulcer and Gastric Secretion in Patients with Liver Disease.

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 haemorrhage 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 operation (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, Timmerman, and Gray, 1960; Clarke, Costarella, and Ward, 1959a; Bendett, Fritz, and Donaldson, 1963). It thus seemed desirable to try to establish whether there is an increased incidence of peptic ulcer in patients with hepatic cirrhosis not associated with alcoholism, for this form predominates in Great Britain. Furthermore, gastric secretion was studied