Anti-inflammatory drugs and variceal bleeding: a case-control study.

BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) can have severe gastrointestinal effects and cause peptic ulcers to bleed. Acute bleeding from oesophageal varices is a major complication of cirrhosis of the liver. AIMS: To investigate the role, using a case-control study, of NSAIDs in first bleeding episodes associated with oesophageal or cardial varices in cirrhotic patients. PATIENTS/METHODS: A structured interview was conducted of 125 cirrhotic patients with bleeding mainly related to oesophageal varices and 75 cirrhotic controls with oesophageal varices who had never bled. RESULTS: Cirrhotic patients who were admitted for bleeding related to portal hypertension were more likely to have used NSAIDs during the week before the index day (31 of 125 (25%)) than the cirrhotic controls (eight of 75 (11%); odds ratio = 2.8, p = 0.016). Use of aspirin alone or combined with other NSAIDs was also more prevalent in the cases (21 of 125 (17%)) than in the controls (three of 75 (4%); odds ratio = 4.9, p = 0.007). Logistic regression analysis showed that NSAID use (p = 0.022, odds ratio = 2. 9, 95% confidence interval = 1.8 to 4.7) and variceal size (p<0.001, odds ratio = 4.0, 95% confidence interval = 1.4 to 11.5) were the only variables independently associated with the risk of bleeding. CONCLUSIONS: Aspirin, used alone or combined with other NSAIDs, was associated with a first variceal bleeding episode in patients with cirrhosis. Given the life threatening nature of this complication, the possible benefit of this treatment should be weighed against the risk shown here. No firm conclusions could be drawn on non-aspirin NSAIDs used alone.

[Gastric protein loss and alcoholic cirrhosis. Study by measurement of gastric clearance of alpha 1-antitrypsin]. / Pertes protéiques gastriques et cirrhose alcoolique. Etude par la mesure de la clairance gastrique de l' alpha 1-antitrypsine.

OBJECTIVE: The aim of the study was to assess gastric protein loss in alcoholic cirrhotic patients, and to determine its role in the low serum albumin levels frequently observed in these patients. METHODS: Twenty-six alcoholic cirrhotic patients with ascites and serum albumin levels < 30 g/L were studied and compared to 6 healthy volunteers. Gastric protein loss was determined by measuring gastric clearance of alpha 1-antitrypsin. RESULTS: Gastric clearance of alpha 1-antitrypsin was 0.96 +/- 1.42 mL/h (median : 0.52; range: 0.11-6.54) in cirrhotic patients and 0.48 +/- 0.20 mL/h (median: 0.51) in healthy volunteers. Values in cirrhotic patients were not significantly different from healthy volunteers. However, 3 cirrhotic patients had high values of gastric clearance of alpha 1-antitrypsin (2.84, 3.99 and 6.54 mL/h). Their serum albumin and protein levels were significantly lower than those in the 23 other patients (P < 0.05 and < 0.03, respectively). Severe portal hypertensive gastropathy was present in two out of these 3 patients and in two out of the 23 other patients. CONCLUSION: Gastric protein loss is not significantly increased in liver cirrhosis. However, in a few patients, this loss is high and may play a role in low serum albumin levels.

[Rate of alcohol abstinence in patients with chronic alcoholic pancreatitis]. / Taux d'abstinence alcoolique chez les malades ayant une pancréatite chronique alcoolique.

OBJECTIVES AND METHODS: The influence of clinical manifestations of alcoholic chronic pancreatitis on the continuation of alcohol intake is still poorly known. The aim was to study the number of patients who stop drinking alcohol and the factors favouring abstinence in 87 patients with alcoholic chronic pancreatitis and to compare them to 59 patients with alcoholic liver disease. Alcoholic abstinence was assessed by patient and relative questionnaire and by blood GGT dosage. RESULTS: The proportion of patients who became abstinent was higher in patients followed at least one year with alcoholic chronic pancreatitis (64%) than in patients with alcoholic liver disease (32%, P < 0.005). Patients mainly withdraw from alcohol in the first year after clinical onset of pancreatitis. The rate of abstinent patients was higher in patients who had presented an acute bout of alcoholic pancreatitis, in patients operated on and in patients with good social status. CONCLUSIONS: Patients with alcoholic chronic pancreatitis frequently withdraw from alcohol, mainly soon after clinical onset of the pancreatitis. This seems to be due to clinical manifestations of the pancreatitis.

[A case of chylous ascites associated with exudative enteropathy complicating chronic pancreatitis of alcoholic origin]. / Un cas d'ascite chyleuse associée à une entéropathie exsudative compliquant une pancréatite chronique d'origine alcoolique.

Chylous ascites is mainly due to malignant abdominal disease or cirrhosis. We report the case of chylous ascites associated with protein losing enteropathy caused by fibrotic compression of abdominal lymphatic vessels and superior mesenteric vein complicating alcohol-related chronic pancreatitis. This is the second case published in the literature.