Reconsideration of Epigastric Pain in Patients with Cirrhotic Ascites 1999.2.23

Reconsideration of Epigastric Pain in Patients with Cirrhotic Ascites 1999.2.23

As previously mentioned, portal hypertension causes congestion of the mesenteric circulation and edema of the mucosa, leading to the manifestation of the principle that “when the liver is diseased, the spleen is affected first!” At this point, three pathogenic mechanisms emerge: ① alterations in gastrointestinal motility, resulting in impaired gastric emptying and intestinal peristalsis; ② increased gastric acid secretion, which serves as a compensatory mechanism; ③ increased fragility of the mesenteric vessels, making them prone to bleeding. These three mechanisms often coexist and mutually reinforce each other. The episodic nature of epigastric pain is generally related to gastric acid irritating ulcerated areas; therefore, cimetidine and ranitidine are highly effective. For severe cases, belladonna derivatives may be added. Overall, the occurrence of epigastric pain in these patients is the result of multiple interrelated mechanisms.