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Old 05-10-2015
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Default cirrhosis copd and pud?

whats the link between copd, liver cirrhosis and peptic ulcer disease? like why does having copd increases the risk of developing duodenal ulcer?
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Old 05-10-2015
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COPD patients like emphysema patients which may have decreased levels of
alpha-1 antitrypsin leading to increased activity of proteases ( which are normally inhibited by alpha-1 antitrypsin) additionally the misfolded alpha-1antitrypsin also accumulates in the hepatopcytes causing damage and eventually resulting in cirrhosis. Thats why we check alpha-1antitrypsin levels in all patients developing premature emphysema(<50years) with concomitant liver disease.

As for the peptic ulcer and COPD link im not sure about that but i think it may be due to the hypercapnia( increased CO2) in COPD patients leading to increased dumping to CO2 in the stomach by parietal cells thus causing ulcers. Thats what i think.
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Old 05-10-2015
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A1AT deficiency was definitely what I was thinking, especially for COPD with concurrent liver disease.

The PUD is interesting. I know that people used to think that A1AT deficiency made you more susceptible to inflammatory damage in general, but I don't know of any good studies that have shown a connection between A1AT and PUD.
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Old 05-11-2015
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according to goljan and kaplan, duodenal peptic ulcers are associated with copd and cirrhosis.
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Old 05-11-2015
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Yeah my sense is that Goljian and Kaplan are simply listing the association but not spelling out the clinical mechanisms behind it.

I just did a literature review and it looks like there isn't any known physiological mechanism connecting these conditions. The association appears to be from these diseases having similar etiologies.

COPD is shown to be a risk factor for PUD, but look at the most common etiology of COPD: smoking, which itself is a PUD risk factor likely 2/2 vasoconstriction, free radical damage, etc. But let's also consider common treatments for COPD: steroids. These are also a significant risk factor for PUD.

For cirrhosis, lets consider the #1 cause again: alcohol. We all know that alcohol is also a huge risk factor for PUD for obvious reasons, so I think that's the connection here.

So for COPD, cirrhosis, and PUD, I think the connection is simply common etiology rather than an occult physiological mechanism.

Interesting question!

Great paper looking at PUD risk factors - PMID: 19160043
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makes sense. thanks
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