Incidence Of Peptic Ulcer Disease In Patients Undergoing Ercp For Pancreato-Biliary Disorders: A Retrospective Study At A Tertiary Care Medical Center

INTRODUCTION: Peptic ulcer disease and biliary disease typically have overlapping symptoms of abdominal pain and frequently require endoscopic evaluation for diagnosis and management. Alteration in the normal biliary physiology due to obstruction effects bicarbonate and biliary secretion which are protective to the duodenal mucosa from the gastric acid secretion. We hypothesize that biliary stasis effects the normal biliary and bicarbonate secretion leading to prolonged exposure of duodenal mucosa to gastric acid resulting in duodenitis and ulcers. Our study aims to investigate any correlation between incidence of duodenitis and PUD in patients with biliary or pancreatic disease undergoing ERCP. METHODS: A retrospective chart review of patients who underwent ERCP between January to June, 2019 at our institute were included. Patients were grouped into six categories these included: (1) choledocholithiasis; (2) chronic pancreatitis; (3) pancreatic cancer; (4) bile leak; (5) cholangiocarcinoma (CCA); and (6) abnormal imaging. Extracted data included several lab values (e.g., AST, ALT) and PUD. Use of non-steroidal and corticosteroids were taken into account in the final data analysis. ANOVA with Bonferonni-corrected post hoc analyses were utilized for continuous measures, and Chi-square were utilized for categorical measures. All analyses were conducted in SPSS (v. 25). RESULTS: Out of the total 77 patients, 41 (53.2%) patients had evidence of duodenitis and 39 (50.6%) patients had evidence of PUD. Female patients accounted for the majority of the sample (62.3%; P = 0.030), though 70% of pancreatic cancer patients were male. For clinical measures, significant differences were found for PUD (X2 = 12.143, P = 0.033), with the greatest percentage for chronic pancreatitis (60%) and CCA (75%) and for duodenitis (X2 = 20.645, P = 0.001), with the greatest percentage for choledocholithiasis (63.4%), Pancreatic cancer (60%). (Figure 1,2). CONCLUSION: Our study represents the first comprehensive research demonstrating increased incidence of duodenitis and PUD in patients undergoing ERCP for Pancreatico - Biliary disorders. Potential limitation includes small sample size, use of side viewing duodenoscope, and lack of Helicobacter pylori testing. This study emphasizes the importance of a more careful mucosal examination during ERCP to diagnose duodenitis and duodenal erosions as these patients may benefit from proton pump inhibitors. Future prospective studies are required to further validate the results of our study.Figure 1.: Incidence of duodenal ulcers in patients with pancreato-biliary disorders.Figure 2.: Incidence of duodenal erosion in patients with pancreato-biliary disorders.