Endoscopic and gastric acid studies in homozygous sickle-cell disease and upper abdominal pain - abstract

ABSTRACT

Patients with homozygous sickle-cell disease frequently experience recurrent upper abdominal pain, the cause of which usually remains unknown. In order to determine the frequency of peptic ulcer disease, upper endoscopic and gastric acid studies were performed in 51 patients with homozygous sickle-cell (SS) disease and recurrent epigastric pain. Twenty (39 percent) had abnormalities in the upper gastrointestinal tract of which 18 (35 percent) had peptic ulcers. The clinical features were similar between patients with ulcers and those with a normal upper gastrointestinal tract. Mean basal and maximum acid output were similar in patients with and those without a duodenal ulcer (DU). Acid output in 15 haematologically normal patients with DU was significantly greater than in those with sickle-cell disease. Since duodenal ulceration in SS disease does not appear to be associated with the high acid output observed in other populations, it may reflect reduced mucosal resistance; this could result from ischaemia. This hypothesis was supported by finding significantly lower foetal haemoglobin levels in SS-DU patients (3.6 percent) than in SS controls (5.7 percent) (AU)