مطالعه ارزیابی فراوانی نسبی زخمها و اروزیونهای پپتیک در بیماران مبتلا به انواع مختلف کلستاز

Introduction: Cholestasis is impairment of normal bile excretion into the duodenum and classified as mechanical and non mechanical cholestasis. Mechanical Cholestasis presents with increase in bile duct diameter or obstruction in bile duct in an ERCP. Cholestasis leads to different complications. One of these complications is mucosal peptic erosion leading to gastrointestinal bleeding, perforation and even obstruction due to stricture. We therefore carried out this study to assess the relative frequency of peptic ulcer and erosion in patients with different type of cholestasis. Methods: In a case control study, 170 patients with mechanical cholestasis on the basis of physical examination, liver function tests, radiologic and serologic assay were candidates for ERCP as final therapeutic and diagnostic test. Collected data was registered in questionnaire and evaluated by the Fisher Test. Later, sonography (common bile duct diameter) in the two groups: mechanical (85 patients) and non mechanical (85 patients) and endoscopy was done for exact survey and location of mucosal erosions. Results: Frequency of mucosal peptic erosions in mechanical cholestatic groups was42.6% ( 36 patients ) and significantly more than frequency of mucosal peptic erosion in non mechanical cholestatic groups (15 patients, 17.6%) (P=0.02). 51 patients (30%) of the total patients with cholestasis had mucosal erosion. From these patients, 25 patients had peptic ulcer [frequency of duodenal ulcer was 17 patients (68%) and gastric ulcer was 8 patients (32%) ](P=0.01). There was significant difference in prevalence of duodenal ulcer in patients with mechanical (12 cases, 70.6%) and non mechanical (5 cases, 29.4%) cholestasis(P=0.01). There was a significant difference between prevalence of duodenal ulcer (12 cases, 70.6%) and gastric ulcer(5 cases, 29.4%) in patients with mechanical cholestasis (P=0.01) but this was not so in patients with non mechanical cholestasis. Conclusion: According to present study, prevalence of duodenal and gastric mucosal lesions in different types of cholestasis is greater than the general population and prevalence of duodenal mucosal lesions in mechanical cholestasis is more than non mechanical Cholestasis.