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DOI: 10.1055/s-2003-39672
© Georg Thieme Verlag Stuttgart · New York
Endoscopic Findings in End-Stage Renal Disease
Publikationsverlauf
Submitted 15 July 2002
Accepted after Revision 14 January 2003
Publikationsdatum:
03. Juni 2003 (online)
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Background and Study Aims: Patients with end-stage renal disease (ESRD) may demonstrate a number of gastrointestinal lesions and suffer subsequent complications. Our aim was to investigate the endoscopic findings in these patients and identify the predisposing factors.
Patients and Methods: During a 1-year period (February 2000 to January 2001), we studied consecutive patients with end-stage renal disease who were undergoing routine endoscopy before renal transplantation. The rapid urease test was also performed to detect Helicobacter pylori infection. Demographic and clinical data were collected. Logistic regression analysis was used to determine the risk factors for important endoscopic lesions, including esophagitis, gastroduodenal erosions, and peptic ulcers.
Results: We studied 206 patients (124 male, 82 female, mean age 38.9). Of the patients 73.8 % were asymptomatic but some patients experienced nausea (12.6 %), heartburn (8.7 %), and abdominal pain (7.3 %). Endoscopy was normal in 74 patients (35.9 %). Abnormal endoscopic findings were duodenal erosions (32.0 %), antral erosions (22.8 %), diffuse antral erythema (27.8 %), duodenal ulcer (7.3 %), esophagitis (5.8 %), angiodysplasia (4.4 %), nodular duodenum (2 %), and inflammatory gastric polyps (1.5 %). The rapid urease test was positive in 58.8 % of patients. Important endoscopic lesions were more common in men and in H. pylori-infected patients. Age, duration of dialysis, cause of the ESRD, presence of any symptoms, and hemoglobin levels were not found to be related to these lesions. Most patients with peptic ulcers were asymptomatic.
Conclusions: Duodenal erosions (32.0 %), gastric erosions (22.8 %), diffuse antral erythema (27.8 %) and duodenal ulcer (7.3 %) are common lesions in patients with end-stage renal disease. Male gender and H. pylori infection are associated with a higher risk of these lesions. As there is no association between patients' symptoms and gastroduodenal lesions, which may increase the risk of post-transplant complications, the development of diagnostic strategies for the detection of these lesions is recommended.
References
- 1 Prakash J, Agrawal B K. Upper gastrointestinal mucosal lesions in chronic renal failure. Indian J Gastroenterol. 1991; 10 131-132
- 2 Gheissari A, Rajyaguru V, Kumashiro R, Matsumoto T. Gastrointestinal hemorrhage in end-stage renal disease patients. Int Surg. 1990; 75 93-95
- 3 Tsai C J, Hwang J C. Investigation of upper gastrointestinal hemorrhage in chronic renal failure. J Clin Gastroenterol. 1996; 22 2-5
-
4 Miles A M, Friesman E A.
Center and home chronic hemodialysis: outcome and complications. In: Schrier RW, Gottschalk CW (eds) Textbook of kidney disease. New York; Little, Brown & Co. 1997 6th ed: 2807-2839 - 5 Feduska N J, Amend W J, Vincenti F. et al . Peptic ulcer disease in kidney transplant recipients. Am J Surg. 1984; 148 51-57
- 6 Kang J Y, Ho K Y, Yeoh K G. et al . Peptic ulcer and gastritis in uraemia, with particular reference to the effect of Helicobacter pylori infection. J Gastroenterol Hepatol. 1999; 14 771-778
-
7 Chan L, Kam I.
Outcomes and complications of renal transplantation. In: Schrier RW, Gottschalk CW (eds) Textbook of kidney disease. New York; Little, Brown & Co. 1997 6th ed: 2720 - 8 Delvaux M, Korman L Y, Armengol-Miro J R. et al . The minimal standard terminology for digestive endoscopy: introduction to structured reporting. Int J Med Inf. 1998; 48 217-225
- 9 Benzo J, Matos M, Milanes C. et al . Endoscopic findings in the upper digestive tract in patients with terminal chronic kidney failure. G E N. 1994; 48 34-38
- 10 Milito G, Taccone-Gallucci M, Brancaleone C. et al . Assessment of the upper gastrointestinal tract in hemodialysis patients awaiting renal transplantation. Am J Gastroenterol. 1983; 78 328-331
- 11 Milito G, Taccone-Gallucci M, Brancaleone C. et al . The gastrointestinal tract in uremic patients on long-term hemodiaylsis. Kidney Int Suppl. 1985; 17 S157-S160
- 12 Musola R, Franzin G, Mora R, Manfrini C. Prevalence of gastroduodenal lesions in uremic patients undergoing dialysis and after renal transplantation. Gastrointest Endosc. 1984; 30 343-346
- 13 Wee A, Kang J Y, Ho M S. et al . Gastroduodenal mucosa in uraemia: endoscopic and histological correlation and prevalence of helicobacter-like organisms. Gut. 1990; 31 1093-1096
- 14 Wright J P, Young G O, Klaff L J. et al . Gastric mucosal prostaglandin E levels in patients with gastric ulcer disease and carcinoma. Gastroenterology. 1982; 82 263-267
- 15 Boyle J M, Johnston B. Acute upper gastrointestinal hemorrhage in patients with chronic renal disease. Am J Med. 1983; 75 409-412
- 16 Korman M G, Laver M C, Hansky J. Hypergastrinemia in chronic renal failure. BMJ. 1972; 1 209-210
- 17 Ventkateswaran P S, Jeffers A, Hocken A G. Gastric acid secretion in chronic renal failure. BMJ. 1972; 4 22-23
- 18 Avram M M. High prevalence of pancreatic disease in chronic renal failure. Nephron. 1977; 18 68-71
- 19 Andriulli A, Malfi B, Recchia S. et al . Patients with chronic renal failure are not at a risk of developing chronic peptic ulcers. Clin Nephrol. 1985; 23 245-248
- 20 Mason E E. Gastrointestinal lesions occurring in uremia. Ann Intern Med. 1952; 37 95-105
- 21 Akdamar K, Ertan A, Agrawal N M. et al . Upper gastrointestinal endoscopy in normal asymptomatic volunteers. Gastrointest Endosc. 1986; 32 78-80
- 22 Abu Farsakh N A, Roweily E, Rababaa M, Butchoun R. Brief report: evaluation of the upper gastrointestinal tract in uraemic patients undergoing hemodialysis. Nephrol Dial Transplant. 1996; 11 847-850
-
23 Dianne B, McKay E L, Milford N E, Tolkoff R.
Management of the patient with renal failure. In: Brenner BM, Rector FC (eds) Brenner & Rector's. The kidney. Philadelphia; Saunders 2000 6th ed: 2548 - 24 Gladziwa U, Haase G, Handt S. et al . Prevalence of Helicobacter pylori in patients with chronic renal failure. Nephrol Dial Transplant. 1993; 8 301-306
- 25 Var C, Gultekin F, Candan F. et al . The effects of hemodialysis on duodenal and gastric mucosal changes in uremic patients. Clin Nephrol. 1996; 45 310-314
- 26 Chalasani N, Cotsonis G, Wilcox C M. Upper gastrointestinal bleeding in patients with chronic renal failure: role of vascular ectasia. Am J Gastroenterol. 1996; 91 2329-2332
- 27 Massarrat S, Saberi-Firoozi M, Soleimani A. et al . Peptic ulcer disease, irritable bowel syndrome and constipation in two populations in Iran. Eur J Gastroenterol Hepatol. 1995; 7 427-433
- 28 Zuckerman G R, Cornette G L, Clouse R E, Harter H R. Upper gastrointestinal bleeding in patients with chronic renal failure. Ann Intern Med. 1985; 102 588-592
R. Sotoudehmanesh, M.D.
Digestive Diseases Research Center · Shariati Hospital
North Kargar Avenue · Tehran 14114 · Iran
Fax: + 98-21-8012992
eMail: setoodeh@ams.ac.ir