Gastropathy in patients with Wilson disease

Abstract

Background: Gastrointestinal symptoms are common in patients with Wilson disease (WD) and may be related to the disease itself or to adverse drug reactions (ADRs).

Aim: To investigate gastroscopy findings in patients with WD and to analyze the risk of gastropathy in the context of different manifestations and treatments of WD as well as Helicobacter pylori infection status.

Methods: This cross-sectional study included patients diagnosed or monitored for WD between 2007 and 2017. All enrolled patients were examined with gastroscopy and checked for infection with a urease test. Based on predominant manifestations, WD was classified as pre-symptomatic, hepatic (only liver symptoms) or neurological. Patients were divided into three treatment groups: untreated, treated with d-penicillamine (DPA) or zinc sulfate therapy.

Results: Of 115 patients, 58 were male and the median age was 30 years. Gastropathy was observed in 65.2% of all patients. Factors that increased the risk of gastropathy were zinc sulfate (odds ratio [OR] = 3.01; 95% confidence interval [CI]: 1.12–8.09, p = .03), H. pylori infection (OR = 2.96; 95%CI: 1.34–6.56, p = .01) and neurological manifestations (OR = 2.55; 95%CI: 1.16–5.60, p = .02). In total, 9.6% of patients had gastric or duodenal ulcers and 29.6% had esophageal varices but no difference was seen by treatment status. In multivariate analysis, zinc sulfate remained associated with higher risk of gastropathy compared with no treatment (OR = 4.57; 95%CI: 1.21–17.19; p = .03) and DPA (OR = 6.28; 95%CI: 1.43–27.56; p = .01).

Conclusions: Our results show that gastropathy in WD may be influenced by the treatment used.

Keypoints

• In a retrospective study of 115 patients with Wilson’s disease, gastric injury was frequent.

• Patients receiving zinc sulfate had increased gastropathy risk compared with those receiving no treatment or d-penicillamine.

Keywords:

• Adverse drug reaction
• d-penicillamine
• zinc
• gastropathy
• Wilson disease

Institutional review board statement

The study was approved by the Bioethics Committee of the Institute of Psychiatry and Neurology in Warsaw, Poland and by the Bioethics Committee of Medical University of Warsaw.

Informed consent statement

Informed consent was obtained from all the patients.

Author contributions

All authors helped to perform the research and contributed to the manuscript writing. Antczak-Kowalska M, Członkowska A. Niewada M, Nehring P, performed the data analysis.

Disclosure statement

The authors declare no conflicts of interest related to this article.