Gastroduodenal changes in adult patients with uncorrected congenital heart disease

The aim of this study is to assess the morphological changes in the stomach and duodenum in a group of adult patients with congenital heart disease who forfeited corrective cardiac surgery during the early part of their life. The study was carried out at Shaab Teaching Hospital, Khartoum, Sudan. All patients who were 15 years or older and referred with congenital heart disease were evaluated by a detailed medical history, physical examination, chest x-ray. electrocardiogram, and echocardiogram. Cardiac catheterization was carried out in 14 patients to confirm the diagnosis. Patients who presented with epigastric pain were further evaluated by double-contrast barium meal and/or upper gastrointestinal endoscopy. Of the 89 cases seen during the period of 1984 to 1990, 23 [26%] had a history of persisting epigastric pain. Upper gastrointestinal abnormalities, proved by endoscopy or barium meal, were seen in 19 [82%] of the 23 patients. Hypertrophic gastritis constituted 61% of the abnormalities; duodenitis, 22%; and duodenal ulcer, 17%. Hypertrophic gastritis was seen in all cases of the cyanosed group and only in 18% of the acyanosed group. This difference is highly significant [P = 0.0001]. Duodenal ulcer occurred exclusively in the cyanosed group. We conclude that hypertrophic gastritis and duodenal ulcer are frequent complications in the long-standing uncorrected cyanotic congenital heart disease. Hypoxia is suggested as a major precipitating factor