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Alhoufie ST, Ibrahim NA, Alhhazmi AA, Makhdoom HM, Ali HM, Hemeg HA, Almutawif YA, Mahallawi WH, Alfarouk KO. Acute Helicobacter pylori Infection Prevalence Among Renal Failure Patients and Its Potential Roles with Other Chronic Diseases: A Retrospective Cohort Study. Infect Drug Resist 2022; 15:6589-6599. [PMID: 36386419 PMCID: PMC9662321 DOI: 10.2147/idr.s388361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 10/28/2022] [Indexed: 11/11/2022] Open
Abstract
Background Helicobacter pylori (H. pylori) infection is relevant to several chronic human diseases, from digestive diseases to renal, metabolic, and cancer diseases. H. pylori infections and chronic kidney diseases are in increasing, global records; if not well controlled in a specific population, these diseases might lead to more clinical complications. Methods In this retrospective study, we investigated the prevalence of acute H. pylori infections among 127 dialysis patients via subjecting their serums to the enzyme-linked immunosorbent assay (ELISA) to detect the human Immunoglobulin M (IgM) against H. pylori infections. Samples were from dialysis patients in a single hemodialysis center in Medina, Saudi Arabia, from January to August 2021. Results Our results indicated the significant prevalence of H. pylori acute infections among 33.1% of renal failure patients recruited in this study, chi-squared: 14.559, p-value: 0.0001. In addition, no significant occurrence of acute H. pylori infection among males and females, chi-squared: 1.823, p-value: 0.177. Furthermore, the prevalence of acute H. pylori infection was not significant in different age groups of renal failure patients. Chi-squared: 6.803, p-value: 0.147, despite H. pylori-infected cases predominantly represented in patients above 51 years. Moreover, we noticed that hypertension, followed by diabetes, was the most prevalent underlying medical condition among acute infected H. pylori and renal failure patients. Conclusion We documented the significant prevalence of acute H. pylori infection among renal failure patients. We also highlighted and discussed the possible potential roles of H. pylori in renal failure and other chronic diseases. Routine screening and treatment for acute H. pylori infection for chronic kidney diseases, hypertension, and diabetes patients would positively reduce the bacterium’s progressive effects on them. They might even improve the control of these diseases.
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Affiliation(s)
- Sari T Alhoufie
- Medical Laboratories Technology Department, College of Applied Medical Sciences, Taibah University, Al- Madinah Al-Munwarah, Saudi Arabia
- Correspondence: Sari T Alhoufie, Medical Laboratories Technology Department, College of Applied Medical Sciences, Taibah University, Al- Madinah Al-Munwarah, Saudi Arabia, Email
| | - Nadir A Ibrahim
- Medical Laboratories Technology Department, College of Applied Medical Sciences, Taibah University, Al- Madinah Al-Munwarah, Saudi Arabia
| | - Areej A Alhhazmi
- Medical Laboratories Technology Department, College of Applied Medical Sciences, Taibah University, Al- Madinah Al-Munwarah, Saudi Arabia
| | - Hatim M Makhdoom
- Medical Laboratories Technology Department, College of Applied Medical Sciences, Taibah University, Al- Madinah Al-Munwarah, Saudi Arabia
| | - Hamza M Ali
- Medical Laboratories Technology Department, College of Applied Medical Sciences, Taibah University, Al- Madinah Al-Munwarah, Saudi Arabia
| | - Hassan A Hemeg
- Medical Laboratories Technology Department, College of Applied Medical Sciences, Taibah University, Al- Madinah Al-Munwarah, Saudi Arabia
| | - Yahya A Almutawif
- Medical Laboratories Technology Department, College of Applied Medical Sciences, Taibah University, Al- Madinah Al-Munwarah, Saudi Arabia
| | - Waleed H Mahallawi
- Medical Laboratories Technology Department, College of Applied Medical Sciences, Taibah University, Al- Madinah Al-Munwarah, Saudi Arabia
| | - Khalid O Alfarouk
- Zamzam Research Center, Zamzam Medical College, Khartoum, Sudan
- Alfarouk Biomedical Research LLC, Temple Terrace, FL, 33617, USA
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Wang X, Jia Z, Zhang Y, Kou C, Jiang J. Association of Helicobacter pylori infection with estimated glomerular filtration rate in a Chinese population. INFECTION GENETICS AND EVOLUTION 2021; 96:105102. [PMID: 34624541 DOI: 10.1016/j.meegid.2021.105102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/25/2021] [Accepted: 09/30/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Helicobacter pylori (H. Pylori) infection is reported to be associated with extragastric disorders which include kidney diseases. But the association between H. pylori infection and estimated glomerular filtration rate (eGFR) is unclear as far. Thus, we performed the study to investigate the prevalence of H. pylori infection and its association with eGFR in a Chinese population. MATERIALS AND METHODS We conducted a cross-sectional study in adults who took health examination at the First Hospital of Jilin University in 2019. All the subjects received 14C-labled urea breath test to determine the H. pylori infection, and we analyzed the relationship between prevalence of H. pylori infection and eGFR. RESULTS Among 3593 participants in the health checkup, the positive rate of H. pylori infection was 37.3%. H. pylori-positive participants had a lower level of eGFR than H. pylori-negative participants. In univariate analysis, we observed that the positive rate of H. pylori infection and RR (relative risk) became larger with eGFR decreased, however, the association was not significant after adjustment for other factors. Further multivariable analysis showed age and sex were the main confounders between eGFR and H. pylori infection. CONCLUSIONS The correlation between eGFR and positive rate of H. pylori infection was confounded by age and sex.
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Affiliation(s)
- Xueying Wang
- Division of Clinical Research, First Hospital of Jilin University, Changchun, Jilin Province, China; Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin Province, China
| | - Zhifang Jia
- Division of Clinical Research, First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Yangyu Zhang
- Division of Clinical Research, First Hospital of Jilin University, Changchun, Jilin Province, China
| | - Changgui Kou
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, Changchun, Jilin Province, China.
| | - Jing Jiang
- Division of Clinical Research, First Hospital of Jilin University, Changchun, Jilin Province, China.
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Use of proton pump inhibitors in dialysis patients: a double-edged sword? J Nephrol 2020; 34:661-672. [PMID: 32710264 DOI: 10.1007/s40620-020-00808-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/15/2020] [Indexed: 12/11/2022]
Abstract
Large cohort-based studies have shown that proton pump inhibitors (PPIs) are linked to rare but multiple and varied secondary events when used in the general population. Although clinicians accept the negative effects of PPIs on renal function, there is a lack of available data regarding the potential consequences of their use by dialysis patients in whom the risk of gastrointestinal bleeding is quite high. This review aims to highlight the risks and benefits of PPIs use in dialysis patients. To summarize, the benefit on the reduction of high digestive bleeding seems certain, but without any beneficial impact on overall survival. The impact on quality of life seems to be significant. The data on the occurrence of peritonitis during PPIs treatment are very contradictory. There is evidence regarding the occurrence of hypomagnesaemia in haemodialysis patients with PPIs; which may lead to increase bone fragility. New data show an increased cardiovascular risk and even a risk of death linked to the use of PPIs on dialysis. Several mechanisms of IPP toxicity are advanced to explain these findings.
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Pakfetrat M, Malekmakan L, Roozbeh J, Tadayon T, Moini M, Goodarzian M. Endoscopic findings in hemodialysis patients upon workup for kidney transplantation. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2020; 31:388-394. [PMID: 32394911 DOI: 10.4103/1319-2442.284013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Upper gastrointestinal (GI) abnormality is believed to be higher in patients with end-stage renal disease (ESRD) which can make a big trouble for whom undergo kidney transplant. We conducted this study to assess upper GI findings of patients with ESRD. In the present retrospective study we recorded upper GI endoscopy results in hemodialysis patients who were candidate for renal transplantation during a 10-year period. We reviewed files of 1256 patients with a mean age of 37.6 ± 13.4 years. Half of patients (50.6%) had an abnormal endoscopy. Two most common abnormalities were mild gastritis (35.6%) and gastro-esophageal reflux disease (16.7%). GI ulcers were observed in 11% of patients. Duodenal ulcer was the most common ulcer which was seen in 6.8% of patients. Helicobacter pylori was positive in 32.9% of patients and correlated with GI lesions (P = 0.000, r = 0.371). Longer dialysis duration and older patients revealed more upper GI abnormality (P = 0 .032, <0.001). As long as more than half of our patients have at least one upper GI involvement, we recommended that endoscopy must be done as a pretransplantation evaluation for patients without symptoms who have risk factors for ulcers.
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Affiliation(s)
- Maryam Pakfetrat
- Department of Internal Medicine; Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Leila Malekmakan
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Jamshid Roozbeh
- Department of Internal Medicine; Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Taraneh Tadayon
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Moini
- Department of Internal Medicine; Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Goodarzian
- Shiraz Nephro-Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Shin SP, Bang CS, Lee JJ, Baik GH. Helicobacter pylori Infection in Patients with Chronic Kidney Disease: A Systematic Review and Meta-Analysis. Gut Liver 2020; 13:628-641. [PMID: 30970438 PMCID: PMC6860029 DOI: 10.5009/gnl18517] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 12/11/2018] [Accepted: 05/27/2018] [Indexed: 12/15/2022] Open
Abstract
Background/Aims Insufficient systematic reviews were conducted in the previous meta-analyses about the prevalence of Helicobacter pylori infection in patients with chronic kidney disease (CKD). The aim of this study was to evaluate the prevalence of H. pylori infection in patients with CKD. Methods A systematic review of studies that evaluated the prevalence of H. pylori infection in patients with CKD compared to a control group was performed. Only studies with adult patients were included, and studies with renal transplant recipients or diabetic nephropathy patients were excluded. Random-effects model meta-analyses with sensitivity analyses and subgroup analyses were conducted to confirm the robustness of the main result. A meta-regression analysis was conducted to explore the influence of potential heterogeneity on the outcomes. The methodological quality of the included publications was evaluated using the Risk of Bias Assessment tool for Nonrandomized Studies. Publication bias was also assessed. Results In total, 47 studies were identified and analyzed. The total prevalence of H. pylori infection was 48.2% (1,968/4,084) in patients with CKD and 59.3% (4,097/6,908) in the control group. Pooled analysis showed a significantly lower prevalence of H. pylori infection in patients with CKD (vs control group: odds ratio, 0.64; 95% confidence interval, 0.52 to 0.79). Sensitivity analyses revealed consistent results, and meta-regression analysis showed no significant confounders. No publication bias was detected. Conclusions The results of this study suggest a lower prevalence of H. pylori infection in patients with CKD.
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Affiliation(s)
- Suk Pyo Shin
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Chang Seok Bang
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea.,Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Korea
| | - Jae Jun Lee
- Institute of New Frontier Research, Hallym University College of Medicine, Chuncheon, Korea.,Department of Anesthesiology and Pain Medicine, Hallym University College of Medicine, Chuncheon, Korea
| | - Gwang Ho Baik
- Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
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Affiliation(s)
- Ji Yong Ahn
- Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Helicobacter pylori Infection May Be Related to Inflammation and Not to Iron Deficiency Anemia in Hemodialysis Patients. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2019. [DOI: 10.1097/ipc.0000000000000736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Fabrizi F, Martin P. Helicobacter Pylori Infection in Patients with End-Stage Renal Disease. Int J Artif Organs 2018. [DOI: 10.1177/039139880002300303] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Affiliation(s)
- F. Fabrizi
- Division of Nephrology and Dialysis, Maggiore Policlinico Hospital, IRCCS, Milano - Italy
- Division of Digestive Disease, UCLA School of Medicine, Los Angeles, CA- USA
| | - P. Martin
- Division of Digestive Disease, UCLA School of Medicine, Los Angeles, CA- USA
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Wijarnpreecha K, Thongprayoon C, Nissaisorakarn P, Jaruvongvanich V, Nakkala K, Rajapakse R, Cheungpasitporn W. Association of Helicobacter pylori with Chronic Kidney Diseases: A Meta-Analysis. Dig Dis Sci 2017; 62:2045-2052. [PMID: 28265827 DOI: 10.1007/s10620-017-4516-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 02/25/2017] [Indexed: 01/11/2023]
Abstract
BACKGROUND/OBJECTIVES The reported risk of chronic kidney disease (CKD) in patients with Helicobacter pylori infection is conflicting. This meta-analysis was conducted to summarize all available data and to estimate the prevalence and association between H. pylori and kidney disease and CKD. METHODS Comprehensive literature review was conducted using MEDLINE and EMBASE database through October 2016 to identify studies that reported the prevalence or the association between H. pylori infection and non-dialysis-dependent kidney diseases or CKD. Effect estimates from the individual study were extracted and combined using random-effect, generic inverse variance method of DerSimonian and Laird. RESULTS Of 4546 studies, nine cross-sectional studies met the eligibility criteria and were included in the meta-analysis. The estimated prevalence of H. pylori infection among subjects with kidney disease was 53% (95% CI 45-61%). The pooled OR of H. pylori in patients with non-dialysis-dependent kidney diseases was 1.20 (95% CI 0.73-1.97) when compared with the patients without kidney diseases. The meta-analysis was then limited to only studies evaluating the risk of H. pylori in CKD; the pooled OR of H. pylori in patients with CKD was 1.00 (95% CI 0.58-1.71). CONCLUSIONS The estimated prevalence of H. pylori in patients with non-dialysis-dependent kidney diseases is 53%. This study does not support the association between H. pylori infection and non-dialysis-dependent kidney diseases nor CKD.
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Affiliation(s)
- Karn Wijarnpreecha
- Department of Internal Medicine, Bassett Medical Center, One Atwell Road, Cooperstown, NY, 13326, USA.
| | - Charat Thongprayoon
- Department of Internal Medicine, Bassett Medical Center, One Atwell Road, Cooperstown, NY, 13326, USA
| | - Pitchaphon Nissaisorakarn
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Kiran Nakkala
- Cape Fear Center for Digestive Disease, P.A., Fayetteville, NC, USA
| | - Ridhmi Rajapakse
- Department of Internal Medicine, Bassett Medical Center, One Atwell Road, Cooperstown, NY, 13326, USA
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Chang SS, Hu HY. Helicobacter pylori: Effect of coexisting diseases and update on treatment regimens. World J Gastrointest Pharmacol Ther 2015; 6:127-136. [PMID: 26558147 PMCID: PMC4635153 DOI: 10.4292/wjgpt.v6.i4.127] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 06/10/2015] [Accepted: 09/15/2015] [Indexed: 02/06/2023] Open
Abstract
The presence of concomitant diseases is an independent predictive factor for non-Helicobacter pylori (H. pylori) peptic ulcers. Patients contracting concomitant diseases have an increased risk of developing ulcer disease through pathogenic mechanisms distinct from those of H. pylori infections. Factors other than H. pylori seem critical in peptic ulcer recurrence in end stage renal disease (ESRD) and cirrhotic patients. However, early H. pylori eradication is associated with a reduced risk of recurrent complicated peptic ulcers in patients with ESRD and liver cirrhosis. Resistances to triple therapy are currently detected using culture-based and molecular methods. Culture susceptibility testing before first- or second-line therapy is unadvisable. Using highly effective empiric first-line and rescue regimens can yield acceptable results. Sequential therapy has been included in a recent consensus report as a valid first-line option for eradicating H. pylori in geographic regions with high clarithromycin resistance. Two novel eradication regimens, namely concomitant and hybrid therapy, have proven more effective in patients with dual- (clarithromycin- and metronidazole-) resistant H. pylori strains. We aim to review the prevalence of and eradication therapy for H. pylori infection in patients with ESRD and cirrhosis. Moreover, we summarized the updated H. pylori eradication regimens.
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Lin SY, Lin CL, Liu JH, Yang YF, Huang CC, Kao CH. Association between Helicobacter pylori infection and the subsequent risk of end-stage renal disease: a nationwide population-based cohort study. Int J Clin Pract 2015; 69:604-10. [PMID: 25644865 DOI: 10.1111/ijcp.12602] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 11/17/2014] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND & AIMS The association between Helicobacter pylori infection and end-stage renal disease (ESRD) events remains unknown. We assessed the relationship between H. pylori infection requiring hospital admission and the subsequent risks of ESRD. METHODS This was a retrospective cohort study in which data from the National Health Insurance system of Taiwan was used. The H. pylori-infected cohort comprised 20,068 patients. Each participant was frequency-matched by age and sex with 4 individuals from the general population without H. pylori-infected. Cox proportional hazards regression analysis was used to estimate the influence of H. pylori infection on the risk of ESRD. RESULTS The overall incidence of ESRD was 3.72 times greater in the H. pylori-infected cohort than in the non-infected cohort (11.1 vs. 2.96 per 1000 person-years), with an adjusted HR of 2.58 [95% confidence interval (CI)=2.33-2.86]. The risk of ESRD markedly increased in patients with H. pylori infection combined with at least one of the following concomitant comorbidities: hypertension, diabetes, hyperlipidaemia and coronary artery disease. CONCLUSIONS This is currently the largest nation-based study in which the risk of ESRD in H. pylori-infected patients was examined. H. pylori infection was associated with a subsequent risk of ESRD. H. pylori-infected patients with concomitant chronic kidney disease (CKD) or cardiovascular disease (CVD) risk factors were at higher risk of ESRD than were those who had a single CKD or CVD risk factor.
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Affiliation(s)
- S-Y Lin
- Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan; Division of Nephrology and Kidney Institute, China Medical University Hospital, Taichung, Taiwan
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Helicobacter pylori Infection in Dialysis Patients: A Meta-Analysis. Gastroenterol Res Pract 2013; 2013:785892. [PMID: 24307895 PMCID: PMC3838798 DOI: 10.1155/2013/785892] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 09/05/2013] [Accepted: 09/19/2013] [Indexed: 12/12/2022] Open
Abstract
Background. Infection with Helicobacter pylori contributes to the etiopathogenesis of various extragastrointestinal conditions, yet its etiological association with either symptomatic or asymptomatic dialysis patients remains inconclusive. Methods. Two researchers working independently conducted a literature search of the online databases PubMed, EMBase, ScienceDirect, and Cochrane Central Register of Controlled Trials to identify relevant articles to the end of 2012. Case-control and cross-sectional studies that met the inclusion criteria were included. Results. Fifteen studies involving 1237 dialysis patients and 1568 controls with normal renal function were included. Compared with normal controls, dialysis patients overall were associated with a relatively lower risk of H. pylori infection though not statistically significant. A significant inverse association was found between H. pylori prevalence and duration of treatments in those who were dialyzed >4 years (odds ratio 0.28; 95% confidence interval 0.22–0.36, P < 0.00001). No relationship between H. pylori status and duration of dialysis was observed in CRF patients. There were no significant differences in endoscopic features between patients and controls. Conclusions. Our meta-analysis found no evidence of a significant association between infection with H. pylori and dialysis overall, whereas long-term treatments of more than four years had a significant protective effect.
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Huang C, Chen Q, Jiang J, Zhang J, Bao B, Yao X. Gastric Metaplasia andHelicobacter pyloriInfection in Hemodialysis Patients. Ren Fail 2012; 34:420-4. [DOI: 10.3109/0886022x.2011.649659] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
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Abstract
Chronic renal failure patients receiving hemodialysis and continuous ambulatory peritoneal dialysis often encounter gastrointestinal troubles over their long treatment period. Helicobacter pylori infection has close association with development of peptic ulcer, gastric cancer and gastric lymphoma, and is thought to be one of the major risk factors for gastrointestinal troubles in dialysis patients. However, it is unclear whether H. pylori infection is directly associated with progression of renal dysfunction and prognosis of chronic renal failure patients. Recent consensus shows that the prevalence of H. pylori infection in chronic renal failure patients is significantly lower than in subjects with normal renal function. In the natural history of H. pylori infection in hemodialysis patients, the prevalence of infection decreases as dialysis periods progressed, in particular within the first four years after the start of treatment. However, the chance of natural eradication becomes rare for patients receiving dialysis treatment for a long time. Moreover, chronic renal failure patients with H. pylori infection have a higher incidence of gastroduodenal diseases, and therefore, are recommended to receive eradication therapies, especially for those receiving treatment for a long time and with higher risks of complication. Intensive endoscopic check-ups for the prevention of gastrointestinal events and the discovery of peptic ulcer and neoplastic diseases at an early phase may be required.
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Affiliation(s)
- Mitsushige Sugimoto
- Department of Medicine-Gastroenterology, Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston, TX, USA
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Helicobacter pylori status and esophagogastroduodenal mucosal lesions in patients with end-stage renal failure on maintenance hemodialysis. J Gastroenterol 2010; 45:515-22. [PMID: 20084526 DOI: 10.1007/s00535-009-0196-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Accepted: 12/15/2009] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The aim of this study was to elucidate the impact of Helicobacter pylori infection on esophagogastroduodenal mucosal lesions in patients with end-stage renal failure on maintenance hemodialysis (HD). METHODS An upper endoscopy and the (13)C-urea breath test were performed in 198 patients on maintenance HD. Clinical features, serum pepsinogen levels and esophagogastroduodenal mucosal lesions were compared between H. pylori-positive and H. pylori-negative patients. Risk factors associated with esophagogastroduodenal mucosal lesion were determined by multivariate analyses. RESULTS The upper endoscopy revealed that gastric erosion was the most frequent (58%) type of esophagogastroduodenal mucosal lesion, followed by duodenal erosion (18%), gastric ulcer (14%), gastroesophageal reflux disease (10%), and duodenal ulcer (7%). Of the 198 patients enrolled in the study, 81 were positive and 117 patients were negative for H. pylori infection. The time duration after the introduction of HD was significantly longer and serum pepsinogen I/II ratio was significantly higher in H. pylori-negative patients than in H. pylori-positive patients. Multivariate analyses revealed that the H. pylori infection was an independent, protective factor for gastric erosion (odds ratio 0.38; 95% confidence interval 0.21-0.70), while the infection was unrelated to other mucosal lesions. CONCLUSIONS The most common mucosal lesion observed in our study cohort, all of whom were patients on maintenance HD, was gastric erosion. The high prevalence of this type of lesion may be explained partly by the cure of H. pylori infection during the clinical course of maintenance HD.
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Sugimoto M, Sakai K, Kita M, Imanishi J, Yamaoka Y. Prevalence of Helicobacter pylori infection in long-term hemodialysis patients. Kidney Int 2008; 75:96-103. [PMID: 18843261 DOI: 10.1038/ki.2008.508] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Patients on hemodialysis often have gastrointestinal complications; however, it is unclear if Helicobacter pylori infection is present in these patients. Here we determined the prevalence of H. pylori infection in 539 Japanese hemodialysis patients by measuring serum anti-H. pylori IgG antibodies. Endoscopy was performed on 299 of these patients and the results were compared to 400 patients with normal renal function who had also undergone endoscopy and sero-testing. A second cohort of 478 dialysis patients, within the original group, was checked serologically for H. pylori infection three times over a four-year observation period. The prevalence of infection in these patients was significantly lower than in those patients with normal renal function, irrespective of the clinical outcomes. The prevalence of H. pylori infection significantly decreased as the duration of dialysis increased, particularly within the first four years following initiation of dialysis. About one-third of patients on dialysis for less than four years became serologically negative for H. pylori infection within this observation period. Our study suggests that although long-term dialysis patients have low prevalence of H. pylori, they still have significant gastroduodenal diseases, such as peptic ulcers, that require endoscopic follow-up.
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Affiliation(s)
- Mitsushige Sugimoto
- Section of Gastroenterology, Department of Medicine, Michael E. DeBakey Veterans Affairs Medical Center, Baylor College of Medicine, Houston, Texas, USA
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Abdulrahman IS, Al-Quorain AA. Prevalence of gastroesophageal reflux disease and its association with Helicobacter pylori infection in chronic renal failure patients and in renal transplant recipients. Saudi J Gastroenterol 2008; 14:183-6. [PMID: 19568535 PMCID: PMC2702933 DOI: 10.4103/1319-3767.41741] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Accepted: 03/24/2008] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND/AIMS The prevalence of gastroesophageal reflux disease (GERD) in chronic renal failure patients and in renal transplant recipients (RTR) has been a subject of discussion in the last few years. Our aims are to clarify this association and its relation to Helicobacter pylori infection, and also to identify possible pathogenic factors in the development of this disease in both groups. METHODS The study involved 40 end-stage renal disease (ESRD) patients with upper gastrointestinal (GI) symptoms (group I), 36 patients who had undergone kidney transplantation and had similar symptoms (group II), and 44 age- and sex-matched controls with the same upper GI symptoms (group III). All patients were subjected to esophagogastroduodenoscopy, and biopsies were obtained from the antrum for histological evaluation and identification of H. pylori. RESULTS The prevalence of GERD in the first two groups was similar (77.5 vs. 75.0%, P = 0.412), while it was significantly lower in the control group (38.6%, P < 0.01). H. pylori infection was present in 40.0, 36.1 (P > 0.05) and 75% (P < 0.01 and < 0.001) of the patients in groups I, II, and III, respectively. Multivariate logistic regression analysis in groups I and II showed that high serum creatinine (Odds ratio [OR] = 6.78, 95% Confidence Interval (CI) = 1.12-45.82), immunosuppressive therapy (OR = 5.78, 95% CI = 1.01-32.5), and absence of H. pylori infection (OR = 3.58, 94% CI = 1.11-18.6) were significantly associated with GERD. The duration of ESRD correlated significantly with the prevalence of GERD in group I. CONCLUSIONS This study showed a similar prevalence of H. pylori infection and GERD in ESRD and RTR patients. GERD prevalence was higher in these two groups than in the controls. Renal transplantation, chronic renal disease, immunosuppressive therapy, and the absence of H. pylori infection seem to be risk factors for the development of GERD.
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Affiliation(s)
- Ibraheim S. Abdulrahman
- Department of Internal Medicine, Nephrology Division, King Fahad University Hospital, Al-Khobar, Saudi Arabia,Address: Dr. Ibrahiem S. Abdulrahman, King Fahad University Hospital, PO Box 40032, Al-Khobar, 31952, Saudi Arabia. E-mail:
| | - Abdulaziz A. Al-Quorain
- Department of Internal Medicine, Gastroenterology Division, King Fahad University Hospital, Al-Khobar, Saudi Arabia
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Seroprevalence of Helicobacter pylori in Central-European uraemic patients and its possible association with presence of HLA-DR12 allele. Eur J Gastroenterol Hepatol 2008; 20:906-11. [PMID: 18794605 DOI: 10.1097/meg.0b013e3282f824d9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Renal disease at any stage is often accompanied by significant gastrointestinal symptoms, and Helicobacter pylori (H. pylori) is closely related to these disorders. A debate is still ongoing on the clinical significance of coexisting uraemia and H. pylori. HLA-class II genes have been repeatedly investigated for predisposition to H. pylori infection. The aim of our work was to evaluate the infection rate among uraemic patients, and study the relationship between HLA antigens and H. pylori serologic status in the same cohort. MATERIALS AND METHODS Data of 709 uraemic patients were collected and analyzed from 2001-2006. 58.7% of patients were male, 41.3% were female, mean age was 45.1 years (SD: +/-14.65). Microlymphocytotoxicity assay was used for typing of HLA class I, PCR-SSP for typing HLA class II alleles and enzyme immunofluorescency for specific H. pylori IgG. RESULTS Of 709 patients, 49.37% were seropositive for H. pylori. Age of H. pylori positive patients was 48.9 versus 41 years of negatives (P<0.0001). Prevalence of H. pylori decreased strongly with year of birth. Significant difference was observed in the occurrence of HLA-DR12 according to H. pylori serology. Of patients carrying DR12, 27 (73%) were H. pylori positive and 10 (27%) were negative [P=0.0037; risk ratios (RR): 2.76]. CONCLUSION H. pylori infection rate and its decrease with year of birth was the same in the uraemic patients and in the normal population, according to specific prevalence figures. Frequency of HLA-DR12 was the same as in the general population; consequently, it might be a possible risk factor for H. pylori seropositivity, at least in a Central-European population.
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Itatsu T, Miwa H, Nagahara A, Kubota M, Miyazaki A, Sato N, Hayashida Y. Eradication of Helicobacter pylori in hemodialysis patients. Ren Fail 2008; 29:97-102. [PMID: 17365917 DOI: 10.1080/08860220601039122] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Helicobacter pylori (H. pylori) are a causative agent of digestive disease. Although a proton pump inhibitor combined with amoxicillin-clarithromycin is the accepted drug treatment for H. pylori eradication in Japan, there is no consensus treatment for hemodialysis patients. STUDY Seventy-seven hemodialysis patients underwent upper digestive tract endoscopy. Biopsy specimens were taken, and histological findings, culture, and rapid urease tests were performed to confirm the presence of H. pylori. H. pylori-positive patients were then administered at random either a seven-day lansoprazole (60 mg a day)-amoxicillin (750 mg a day)-clarithromycin (400 mg a day) (LAC) regimen or a seven-day lansoprazole (60 mg a day)-clarithromycin (400 mg a day) (LC) regimen. The success of H. pylori eradication was determined from histological findings, culture, and rapid urease tests. RESULTS In 13 of 77 patients (13.6%), ulcers and/or ulcer scars were seen by endoscopy. Thirty-one patients (40.3%) were positive for H. pylori, and 20 patients among them were randomized to one of two regimens: one is seven-day LAC regimen (eleven patients) and the other is seven-day LC regimen (nine patients). Eradication was successful in nine of the eleven patients (72.7%) receiving the LAC regimen, but in only three of the nine patients (33.3%) who underwent the LC regimen. No serious adverse effects were observed with either regimen, and 95% of the patients reported complete compliance. CONCLUSION A seven-day low dose LAC regimen is safe and effective and recommended for treatment of H. pylori infection in hemodialysis patients.
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Affiliation(s)
- Tomoko Itatsu
- Department of Internal Medicine, Juntendo Koshigaya Hospital, Saitama, Japan.
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Dyspepsia in Turkish patients on continuous ambulatory peritoneal dialysis. Int Urol Nephrol 2008; 40:211-7. [PMID: 18196468 DOI: 10.1007/s11255-007-9324-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2007] [Accepted: 12/12/2007] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND AIMS Although dyspepsia is very common in uremic patients, there is not much data on the prevalence of dyspepsia undergoing continuous ambulatory peritoneal dialysis (CAPD). The aims of this study are to assess the prevalence of dyspepsia, Helicobacter pylori, and the association between dyspeptic symptoms and diabetes. METHODS One hundred and thirty CAPD patients were included in the study. The presence or absence of dyspepsia was assessed by using the Hong Kong Index of Dyspepsia (HKID) Questionnaire. A score of >or=16 indicates the presence of dyspepsia. The patients who were diagnosed with dyspepsia had endoscopic examination and were judged to be infected with H. pylori if the organism was demonstrated in the biopsy. RESULTS Sixty-four of 130 CAPD patients (49.2%) had a HKID score of 16 or more. H. pylori was identified in 17 of 64 CAPD patients with dyspepsia (26.6%). Thirty-four patients (25.8%) were diabetic, and there was no association between diabetes and dyspepsia (P=0.68). The most frequent finding in patients with dyspepsia was gastritis or gastric ulcer in endoscopic evaluation. The mean serum albumin level was also not statistically significantly different between the two groups. CONCLUSIONS Dyspepsia is common and the prevalence of H. pylori infection is 26.6% in our CAPD patients with dyspepsia. Dyspepsia is not associated with the presence of H. pylori and diabetes in CAPD patients. Large-scale studies are needed to elucidate dyspepsia related risk factors and physiopathological mechanisms.
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Khedmat H, Ahmadzad-Asl M, Amini M, Lessan-Pezeshki M, Einollahi B, Pourfarziani V, Naseri MH, Davoudi F. Gastro-duodenal lesions and Helicobacter pylori infection in uremic patients and renal transplant recipients. Transplant Proc 2007; 39:1003-7. [PMID: 17524875 DOI: 10.1016/j.transproceed.2007.03.034] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Upper gastrointestinal (UGI) symptoms are common in uremic patients, and higher serum levels of urea have been suggested to be related to Helicobacter pylori (HP) colonization and UGI mucosal inflammation. AIM The aim of this study was to compare HP infection and UGI endoscopic findings between uremic patients, renal transplant (RT) recipients, and controls. METHODS A total of 474 subjects (71 chronic renal failure [CRF], 73 hemodialysis [HD], 25 Tx, and 305 controls) from Baqyiatallah Hospital, Tehran, Iran were recruited between April 2002 and March 2004 for evaluation of dyspepsia, excluding those receiving any HP-eradication therapy. All subjects were examined for esophagus, stomach and duodenum mucosa, and infection with HP on 2 distinct tissue samples of the anthral region. RESULTS Four groups of subjects (mean +/- 2 se; age, 45 +/- 1.6 years; 62.9% male) were studied. Duodenal ulcer in the uremic patients (CRF, 16.1%; HD, 13.7%) was more common than that in the RT-recipients (8%) and controls (6.5%); P=.038. Erosive gastritis and duodenal bulb deformity were also more common in the uremic subjects (CRF, 23.9%, 36.9%; HD, 30.1%, 20.5%, respectively) than those in the other subjects (RT recipients, 16%, 8%; controls, 8.2%; 0%, respectively); P<.001. HP infection was found to be higher in the uremic patients (CRF, 66.2%; HD, 63%) than in the RT recipients (40%) and controls (34.8%); P<.001. CONCLUSION Higher rates of gastric and duodenal mucosal lesions and HP infection in the uremic patients in comparison with the subjects with normal renal function may have resulted from higher serum levels of urea, anemia, and fluctuations in the gastric blood supply in the CRF and HD patients. However, more tenable evidence from controlled trials is required for the eradication of HP in all uremic patients and transplantation candidates.
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Affiliation(s)
- H Khedmat
- Baqyiatallah Research Center for Gastroenterology and Liver Diseases, Department of Internal Medicine, Baqyiatallah University of Medical Sciences, Tehran, Iran
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Tseng GY, Lin HJ, Fang CT, Yang HB, Tseng GC, Wang PC, Hung TL, Deng YC, Cheng YT, Huang CH. Recurrence of peptic ulcer in uraemic and non-uraemic patients after Helicobacter pylori eradication: a 2-year study. Aliment Pharmacol Ther 2007; 26:925-33. [PMID: 17767477 DOI: 10.1111/j.1365-2036.2007.03438.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The role of Helicobacter pylori in the pathogenesis of peptic ulcer disease in patients with uraemia remains unclear. AIM To evaluate the long-term effect of H. pylori eradication in these patients. METHODS Uraemic and non-uraemic patients with peptic ulcer were enrolled in this study. Patients having history of non-steroidal anti-inflammatory drugs use or cardiovascular disease that need aspirin use were excluded. After confirmation of H. pylori infection, they received a triple therapy and were followed up for 2 years. RESULTS Between September 1999 and December 2005, 34 patients (41%) of the end-stage renal disease [H. pylori (+) group] and 67 (84%) of the non-uraemic patients with peptic ulcer disease (PU group) received anti-H. pylori therapy. After triple therapy, 32 (94%) from the end-stage renal disease group and 64 (96%) from the peptic ulcer group obtained successful eradication. During the 2-year follow-up, three patients in the end-stage renal disease group were excluded because of the presence of cardiovascular disease and aspirin use in two cases and died of heart failure in one case; two patients in peptic ulcer group refused follow-up. Finally, 29 uraemic and 62 non-uraemic patients had achieved the follow-up. Recurrence of peptic ulcer was more in the end-stage renal disease group than in the peptic ulcer group with intention-to-treat analysis (eight of 32, 25% vs. two of 64, 3%, P = 0.001, OR: 10.0, 95% CI: 1.979-50.540) or per-protocol analysis (eight of 29, 28% vs. two of 62, 3%, P < 0.001, OR: 11.4, 95% CI: 2.245-58.168). CONCLUSIONS Peptic ulcer recurrence after H. pylori eradication is higher in end-stage renal disease patients with peptic ulcer than in peptic ulcer patients without renal disease. Factors aside from H. pylori play an important role in peptic ulcer recurrence in end-stage renal disease patients.
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Affiliation(s)
- G-Y Tseng
- Division of Gastroenterology, Ton-Yen General Hospital, Hsin-Chu, Taiwan
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Lentine KL, Parsonnet J, Taylor I, Wrone EM, Lafayette RA. Associations of serologic markers of infection and inflammation with vascular disease events and mortality in American dialysis patients. Clin Exp Nephrol 2006; 10:55-62. [PMID: 16544178 DOI: 10.1007/s10157-005-0392-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2005] [Accepted: 10/04/2005] [Indexed: 11/25/2022]
Abstract
BACKGROUND Inflammatory markers predict cardiovascular risk and mortality in endstage renal disease. The relationship of chronic infections to inflammation and vascular disease events has not been reported among American dialysis patients. METHODS We performed a cross-sectional and prospective study of a multiracial cohort of 97 chronic hemodialysis patients in California. Anti-Chlamydia pneumoniae IgA and IgG antibodies (Cp-IgA and Cp-IgG), anti-Helicobacter pylori antibodies (Hp-IgG), and highly sensitive C-reactive protein (hsCRP) levels were measured at enrollment. We ascertained the prevalence of atherosclerotic vascular (coronary artery, cerebrovascular, and peripheral vascular) disease (AVD) events, and observed participants for at least 1 year for incident events and mortality. We defined statistical significance as P < 0.01. RESULTS Elevated hsCRP levels (77%) and seropositivity to C. pneumoniae were common (Cp-IgA, 49%; Cp-IgG, 64%), whereas the seroprevalence of Hp-IgG was relatively low (25%). The hsCRP levels did not vary with infection status. In bivariate analysis, Cp-IgA and Cp-IgG were each associated with approximately fourfold higher odds of prevalent AVD (P < 0.01). Although anti-chlamydial antibodies maintained nearly significant associations with AVD after covariate adjustment (P < 0.05), antibodies did not predict outcomes over the period of observation. However, hsCRP was a nearly significant independent predictor of prevalent AVD (P = 0.02) and of mortality during follow-up (P = 0.01). We did not detect an association of Hp-IgG with any study outcome. CONCLUSIONS Our findings generalize a possible link between C. pneumoniae and prevalent atherosclerosis in American hemodialysis patients and confirm the importance of hsCRP as a prognostic indicator. Our work does not support H. pylori as an important mediator of cardiovascular risk in dialysis patients.
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Affiliation(s)
- Krista L Lentine
- Saint Louis University Center for Outcomes Research Salus Center, 2nd Floor, 3545 Lafayette Avenue, MO 63104, USA.
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Šimunić M, Ljutić D, Miše S, Pešutić-Pisac V, Tonkić M, Hozo I. Helicobacter pylori eradication for the treatment of dyspeptic symptoms in chronic renal failure. Ann Saudi Med 2005; 25:425-7. [PMID: 16270770 PMCID: PMC6089731 DOI: 10.5144/0256-4947.2005.425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Miroslav Šimunić
- Clinical Hospital Split, Department of Gastroenterology and Hepatology, Split, Croatia
| | - Dragan Ljutić
- Clinical Hospital Split, Department of Nephrology, Split, Croatia
| | - Stjepan Miše
- Clinical Hospital Split, Department of Gastroenterology and Hepatology, Split, Croatia
| | | | - Marija Tonkić
- Clinical Hospital Split, Department of Microbiology, Split, Croatia
| | - Izet Hozo
- Clinical Hospital Split, Department of Gastroenterology and Hepatology, Split, Croatia
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Chu KM, Kwok KF, Law S, Wong KH. Patients with Helicobacter pylori positive and negative duodenal ulcers have distinct clinical characteristics. World J Gastroenterol 2005; 11:3518-22. [PMID: 15962366 PMCID: PMC4315952 DOI: 10.3748/wjg.v11.i23.3518] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the clinical characteristics of Helicobacter pylori (H pylori) negative duodenal ulcer.
METHODS: Patients with an endoscopic diagnosis of duodenal ulcer between 1996 and 2002 were included in the present study. Patients were considered to be negative for H pylori, if both histological examination and rapid urease test of biopsy specimens were negative. A comparison was made between patients with H pylori positive and negative duodenal ulcers.
RESULTS: A total of 1 343 patients were studied. Their mean age was 54.7±0.5 years. There was a male preponderance (M:F = 2.5:1). Three hundred and ninety-eight patients (29.6%) did not have H pylori infection. The annual proportion of patients with H pylori negative duodenal ulcers increased progressively from 1996 to 2002. On multivariate analysis, patients with H pylori negative duodenal ulcer were more likely to be older, have concomitant medical problem, pre-existing malignancy, recent surgery, underlying sepsis, or taken non-steroidal anti-inflammatory drugs. In terms of clinical presentations, patients with H pylori negative duodenal ulcer were more likely to present with bleeding, multiple ulcers and larger ulcers.
CONCLUSION: The proportion of patients with H pylori negative duodenal ulcers is on the rise because of a continued drop in incidence of H pylori positive duodenal ulcers in recent years. Such patients have distinct clinical characteristics and it is important to ascertain the H pylori status before starting eradication therapy.
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Affiliation(s)
- Kent-Man Chu
- Department of Surgery, University of Hong Kong Medical Center, Queen Mary Hospital, Pokfulam, Hong Kong, China.
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Sezer S, Ibiş A, Ozdemir BH, Ozdemir FN, Külah E, Boyacioğlu S, Haberal M. Association of helicobacter pylori infection with nutritional status in hemodialysis patients. Transplant Proc 2004; 36:47-9. [PMID: 15013297 DOI: 10.1016/j.transproceed.2003.11.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The presence of Helicobacter pylori (HP) infection may adversely influence outcome in renal transplant candidates because of its strong association with gastrointestinal disorders. We examined the association between HP infection and nutritional parameters in symptom-free hemodialysis patients and assessed prospectively the nutritional changes in patients who received therapy for the disease. The 163 study patients, including 114 men and 69 women of mean age 41.5 +/- 12.9 years on dialysis for 67.2 +/- 47.6 months, were selected from among the group who underwent routine endoscopic evaluation according to our renal transplant protocol. Patients with active peptic ulcer, acute gastritis, chronic inflammatory disease, malignancy, or diabetes mellitus were excluded. Endoscopy results revealed normal findings in 60 (group 1), gastritis in 86 (group 2), or gastritis with HP in 17 patients (group 3). Group 3 patients received a 2-week course of triple therapy (omeprazole, amoxicillin, clarithromycin). The patient groups were compared for nutritional metrics (albumin, phosphorus, interdialytic weight gain [IDWG], body mass index [BMI]), inflammatory indices (CRP, fibrinogen), and iPTH levels. Group 3 patients were observed to be malnourished when compared with groups 1 and 2, namely abnormal values of albumin (P <.0001), phosphorus (P <.009), IDWG (P <.03), and BMI (P <.02). Repeat endoscopy revealed a 94% rate of eradication of HP with increased levels of albumin and phosphorus in group 3. Although symptom-free hemodialysis patients with HP-associated gastritis displayed a state of malnutrition; its eradication improved the nutritional status. Therefore, the presence of HP infection should be sought and its eradication mandatory for this patient population.
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Affiliation(s)
- S Sezer
- Department of Nephrology, Başkent University, Ankara, Turkey
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Strid H, Simrén M, Stotzer PO, Abrahamsson H, Björnsson ES. Delay in gastric emptying in patients with chronic renal failure. Scand J Gastroenterol 2004; 39:516-20. [PMID: 15223673 DOI: 10.1080/00365520410004505] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Gastrointestinal (GI) symptoms are common in patients with chronic renal failure (CRF). Delayed gastric emptying might be a possible pathophysiological mechanism. The aims of this study were to evaluate gastric emptying in patients with CRF and to correlate the findings with GI symptoms and evaluate the impact of Helicobacter pylori infection in CRF patients on gastric emptying. METHODS Thirty-nine patients with CRF (17 F, 22 M) were compared with 131 healthy subjects (74 F, 57 M). A standardized breakfast was given with 20 spherical, radiopaque markers (ROMs). The emptying was followed by fluoroscopy after 4, 5 and 6 h. Gastric emptying was assessed by calculating the individual mean percentual gastric retention of markers, 4 to 6 h after the meal. The perceived severity of GI symptoms was assessed with a validated questionnaire. Because of gender differences in gastric emptying, men and women were compared separately and a percentile of 95 was chosen as the upper reference value. H. pylori infection was assessed using a serological method. RESULTS Delayed gastric emptying was found in 14 out of 39 (36%) of the CRF patients. There was no relationship between delayed gastric emptying and age, GI symptoms, H. pylori infection or underlying renal disease. However, a higher proportion of patients in peritoneal dialysis demonstrated delayed gastric emptying compared with predialytic patients (6 of 9 versus 2 of 13, P = 0.026). Men with CRF had a higher gastric retention compared with healthy men (16.6 (0-63.3)% versus 0 (0-2.1)%, P < 0.0001), and 10 men with CRF had delayed gastric emptying (P < 0.0001). There was no significant difference in mean gastric retention between women with CRF and healthy women (13.3 (0-55.4)% versus 10.8 (0-30.0)%, P = 0.93), but 4 women with CRF had delayed gastric emptying (P = 0.02). Eighteen of the CRF patients had GI symptoms (6 F, 12 M) and 21 were asymptomatic (11 F, 10 M). There was no difference in mean gastric retention in patients with CRF with and without GI symptoms (M: 13.3 (0-55.0)% versus 47.5 (5.0-65.0)%, P = 0.51, F: 16.6 (0-63.3)% versus 13.3 (0-59.2)%, P = 0.96). Gastric emptying in CRF patients with and without H. pylori infection showed no difference. CONCLUSIONS Delayed gastric emptying is common in patients with chronic renal failure, particularly in men. The delay was not associated with the presence of GI symptoms, underlying renal disease or H. pylori infection. However, the dialytic status might have an impact on gastric emptying in patients with CRF.
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Affiliation(s)
- H Strid
- Dept. of Internal Medicine, Sahlgrenska University Hosptial, Göteborg, Sweden.
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Marsenic O, Peco-Antic A, Perisic V, Virijevic V, Kruscic D, Kostic M. Upper gastrointestinal lesions in children on chronic haemodialysis. Nephrol Dial Transplant 2004; 18:2687-8. [PMID: 14605311 DOI: 10.1093/ndt/gfg468] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Pakodi F, Abdel-Salam OM, Debreceni A, Mózsik G. Helicobacter pylori. One bacterium and a broad spectrum of human disease! An overview. JOURNAL OF PHYSIOLOGY, PARIS 2000; 94:139-52. [PMID: 10791696 DOI: 10.1016/s0928-4257(00)00160-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Since the historical rediscovery of gastric spiral Helicobacter pylori in the gastric mucosa of patients with chronic gastritis by Warren and Marshall in 1983, peptic ulcer disease has been largely viewed as being of infectious aetiology. Indeed, there is a strong association between the presence of H. pylori and chronic active gastritis in histology. The bacterium can be isolated in not less than 70% of gastric and in over 90% of duodenal ulcer patients. Eradication of the organism has been associated with histologic improvement of gastritis, lower relapse rate and less risk of bleeding from duodenal ulcer. The bacterium possesses several virulence factors enabling it to survive the strong acid milieu inside the stomach and possibly damaging host tissues. The sequence of events by which the bacterium might cause gastric or duodenal ulcer is still not fully elucidated and Koch's postulates have never been fulfilled. In the majority of individuals, H. pylori infection is largely or entirely asymptomatic and there is no convincing data to suggest an increase in the prevalence of peptic ulcer disease among these subjects. An increasingly growing body of literature suggests an association between colonization by H. pylori in the stomach and a risk for developing gastric mucosa-associated lymphoid tissue (MALT), MALT lymphoma, gastric adenocarcinoma and even pancreatic adenocarcinoma. The bacterium has been implicated also in a number of extra-gastrointestinal disorders such as ischaemic heart disease, ischaemic cerebrovascular disease, atherosclerosis, and skin diseases such as rosacea, but a causal role for the bacterium is missing. Eradication of H. pylori thus seems to be a beneficial impact on human health. Various drug regimens are in use to eradicate H. pylori involving the administration of three or four drugs including bismuth compounds, metronidazole, clarithromycin, tetracyclines, amoxycillin, ranitidine, omeprazole for 1-2 weeks. The financial burden, side effects and emergence of drug resistant strains due to an increase in the use in antibiotics for H. pylori eradication therapy need further reconsideration.
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Affiliation(s)
- F Pakodi
- First Department of Medicine, Medical University of Pécs, Hungary
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Araki H, Miyazaki R, Matsuda T, Gejyo F, Koni I. Significance of serum pepsinogens and their relationship to Helicobacter pylori infection and histological gastritis in dialysis patients. Nephrol Dial Transplant 1999; 14:2669-75. [PMID: 10534510 DOI: 10.1093/ndt/14.11.2669] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Previous investigations reported that patients undergoing dialysis therapy had significantly higher serum pepsinogen (PG) levels than patients with normal renal function. However, in dialysis patients, the relationship between serum PG levels and Helicobacter pylori infection remains unknown. METHODS Sixty three maintenance dialysis patients (54 haemodialysis and nine continuous ambulatory peritoneal dialysis) who required endoscopic examination were enrolled in the study. Sixty four age- and sex-matched patients with normal renal function served as controls. We performed endoscopic examination and obtained both the gastric antral and corpus mucosa for histopathological evaluation and H. pylori identification. Twenty three patients on dialysis underwent H. pylori eradication therapy. RESULTS In dialysis patients, H. pylori-positives had significantly higher serum PG II levels than H. pylori-negatives (26.6+/-21.5 vs 14.1+/-7.1 ng/ml, P<0.05), but no significant difference was found in serum PG I between H. pylori-positives and H. pylori-negatives (228.8+/-158.5 vs 179. 4+/-113.5 ng/ml). There was no significant difference in serum PG II between dialysis patients and controls (19.9+/-16.5 vs 18.6+/-14.9 ng/ml), while serum PG I levels were significantly higher in dialysis patients than in controls (201.7+/-136.8 vs 77.6+/-85.8 ng/ml, P<0.05). Serum PG II levels, but not those of PG I, significantly correlated with the inflammation and activity scores of antrum in dialysis patients, and these scores were highly influenced by H. pylori infection. Dialysis patients in whom H. pylori was eradicated successfully showed significant reductions of serum PG II levels but not of PG I. CONCLUSIONS In dialysis patients, high serum levels of PG II, but not PG I, are significantly related to H. pylori infection and mucosal inflammation. A significant decrease in serum PG II levels could be used as a predictor of the eradication of H. pylori infection in dialysis patients.
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Affiliation(s)
- H Araki
- Second Department of Internal Medicine, School of Medicine, Kanazawa University, Kanazawa, Japan
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Fabrizi F, Martin P, Dixit V, Quan S, Brezina M, Abbey H, Gerosa S, Kaufman E, DiNello R, Polito A, Gitnick G. Epidemiology of Helicobacter pylori in chronic haemodialysis patients using the new RIBA H. pylori SIA. Nephrol Dial Transplant 1999; 14:1929-33. [PMID: 10462273 DOI: 10.1093/ndt/14.8.1929] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND There are few data concerning the epidemiology of H. pylori in patients on chronic haemodialysis (HD) treatment. These surveys concerned small populations and were made with ELISA technique. However, ELISA-based assays do not differentiate between strains of H. pylori that are associated with ulcers. Recent literature reports that formation of ulcers correlates strongly with the expression of cytotoxin-associated protein (CagA) and vacuolating cytotoxin (VacA) of H. pylori. METHODS A novel serological test (RIBA H. pylori strip immunoblot assay (SIA)) has been recently introduced, it uses the H. pylori lysate (Lys) along with two additional purified recombinant antigens derived from CagA and VacA of H. pylori. AIM To study the epidemiology of H. pylori using RIBA H. pylori SIA among chronic HD patients and blood donors as a control group. In addition, the activity of H. pylori was analysed by immunoblot technique in a group of patients with documented ulcers and normal renal function. RESULTS The prevalence of antibody towards H. pylori among HD patients, blood donors, and patients with documented ulcers was 56% (127/228), 53% (84/158), and 100%, (21/21) respectively; the difference was significant (P=0.0001). The frequency of anti-H. pylori-positive individuals was significantly higher in patients with documented ulcers than HD patients and blood donors, 21/21 (100%) vs 211/386 (55%), P=0.0001. The frequency of antibody to H. pylori in the HD population was significantly associated with race (P= 0.005); no relationship between anti-H. pylori antibody and numerous demographic, biochemical, and clinical features of patients was seen. The frequency of antibodies against virulent strains of H. pylori in HD patients and blood donors with H. pylori was 60% (76/127) and 61% (51/84) respectively; it was 86% (18/21) among individuals with documented ulcers. No significant difference among these three groups occurred. CONCLUSIONS The frequency of antibody towards H. pylori by RIBA H. pylori SIA was high both in HD patients and blood donors; patients with documented ulcers and normal renal function had significantly higher frequency of anti-H. pylori antibody. The anti-H. pylori antibody rate among HD patients was strongly associated with race. The prevalence of antibody against virulent strains of H. pylori did not change among HD patients and control groups. Studies in large cohorts of HD patients with documented peptic ulcer disease are in progress.
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Affiliation(s)
- F Fabrizi
- Division of Digestive Diseases, UCLA School of Medicine, Los Angeles, CA, USA
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