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Sahara S, Sugimoto M, Murata M, Iwata E, Kawai T, Murakami K, Yamaoka Y, Shimoyama T. Eradication Therapy for Helicobacter pylori Infection in Patients Receiving Hemodialysis: Review. Helicobacter 2024; 29:e13106. [PMID: 38984746 DOI: 10.1111/hel.13106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 05/15/2024] [Accepted: 06/05/2024] [Indexed: 07/11/2024]
Abstract
Patients receiving hemodialysis (HD) often develop gastrointestinal diseases. Recently, although in general population, clinical guidelines for Helicobacter pylori have strongly recommended its eradication in patients to prevent gastric cancer, optimal eradication regimen and optimal dosage of drugs for patients receiving HD have not been established, due to possible incidence of adverse events. Some antimicrobial agents used in eradication therapy, particularly amoxicillin, can exacerbate renal dysfunction. Given the delayed pharmacokinetics of drugs in patients receiving HD compared with those in healthy individuals, drug regimen and dosage should be considered to minimize adverse effects. Although previous studies have investigated the benefits of eradication therapy for patients receiving HD, because most studies were small in terms of the number of enrolled patients, it is hard to show evidence. The numbers of eradication in HD patients have recently increased, and it is important to provide an optimal regimen. The consideration of eradication in patients undergoing HD with a reduction in the drug dose by 1/2-1/3 may prevent adverse events. Additionally, another important consideration is whether adverse events can be prevented while maintaining a similar eradication rate with reduced drug dosages. Recent meta-analysis findings indicate comparable eradication rates in patients receiving HD and healthy individuals, both with the same dosage regimen and at a reduced dosage regimen, with no significant differences (relative risk [RR] for successful eradication: 0.85 [95% confidence interval (CI): 0.48-1.50]). Unlike with the same dosage regimen (RR for adverse events: 3.15 [95% CI: 1.93-5.13]), the adverse events in the dosage reduction regimen were similar to those in healthy individuals (RR: 1.26 [95% CI: 0.23-6.99]). From a pharmacological perspective, the eradication regimen in patients receiving HD should consider the dosage (1/2-1/3 dosage), dosing number (bid), dosing timing of drugs (after HD), and susceptibility to antimicrobial agents.
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Affiliation(s)
- Shu Sahara
- Department of Gastroenterology, Hamamatsu Medical Center, Hamamatsu, Japan
| | - Mitsushige Sugimoto
- Division of Genome-Wide Infectious Diseases, Research Center for GLOBAL and LOCAL Infectious Disease, Oita University, Yufu, Japan
| | - Masaki Murata
- Department of Gastroenterology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Eri Iwata
- Department of Gastroenterological Endoscopy, Tokyo Medical University Hospital, Shinjuku, Japan
| | - Takashi Kawai
- Department of Gastroenterological Endoscopy, Tokyo Medical University Hospital, Shinjuku, Japan
| | | | - Yoshio Yamaoka
- Department of Environmental and Preventive Medicine, Oita University, Yufu, Japan
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Goldman S, Zhao J, Bieber B, Pisoni RL, Horowitz L, Nessim SJ, Piraino B, Lambie M, Kanjanabuch T, Ito Y, Boudville N, Teitelbaum I, Schreiber M, Perl J. Gastric Acid Suppression Therapy and Its Association with Peritoneal Dialysis-Associated Peritonitis in the Peritoneal Dialysis Outcomes and Practice Patterns Study (PDOPPS). KIDNEY360 2024; 5:370-379. [PMID: 38019215 PMCID: PMC11000729 DOI: 10.34067/kid.0000000000000325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 11/15/2023] [Indexed: 11/30/2023]
Abstract
Key Points In a large multinational cohort of PD patients, any GAS use was not associated with an increased risk of all-organism peritonitis. For peritonitis, risks were particularly high among certain classes of organisms particularly for Gram-negative, enteric, and streptococcal peritonitis episodes. The association with enteric peritonitis appeared to be stronger among H2RA users. Background Peritonitis is a major peritoneal dialysis–related complication. We determined whether gastric acid suppression (GAS) (proton pump inhibitor [PPI] or histamine-2 receptor antagonists [H2RAs]) use was associated with all-cause and organism-specific peritonitis in peritoneal dialysis patients. Methods In the Peritoneal Dialysis Outcomes and Practice Patterns Study (595 facilities, eight countries, years 2014–2022), associations between GAS use and time to first episode of all-cause peritonitis were examined using Cox proportional hazards models. The primary exposure of interest was GAS and secondarily PPI or H2RA use. Secondary outcomes were organism-specific peritonitis, peritonitis cure rates, and death. Results Among patients (N =23,797) at study baseline, 6020 (25.3%) used PPIs, and 1382 (5.8%) used H2RAs. Overall risks of GAS use and peritonitis risk (adjusted hazard ratio [AHR]=1.05, 95% confidence interval [CI], 0.98 to 1.13]) and use of PPI (AHR 1.06 [95% CI, 0.99 to 1.14]) or H2RA (AHR 1.02 [95% CI, 0.88 to 1.18]) did not reach statistical significance. In organism-specific analyses, GAS users displayed higher peritonitis risks for Gram-negative (AHR 1.29, 95% CI, 1.05 to 1.57), Gram-positive (AHR 1.15, 95% CI, 1.01 to 1.31), culture-negative (AHR 1.20, 95% CI, 1.01 to 1.42), enteric (AHR 1.23, 95% CI, 1.03 to 1.48), and particularly Streptococcal (AHR 1.47, 95% CI, 1.15 to 1.89) peritonitis episodes. GAS was also associated with higher overall mortality (AHR 1.13 [95% CI, 1.05 to 1.22]). Conclusion The association between GAS use and peritonitis risk was weaker (hazard ratio [HR] 1.05 [0.98 to 1.13]) than for streptococcal (HR 1.57 [1.15 to 1.89]) and Gram-negative (HR 1.29 [1.05 to 1.57]) peritonitis. A better understanding of mechanisms surrounding the differential effects of GAS subtype on peritonitis risks is needed. Clinicians should be cautious when prescribing GAS. The impact of GAS deprescribing on peritonitis risk requires further evaluation.
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Affiliation(s)
- Shira Goldman
- Division of Nephrology, St. Michael's Hospital, Toronto, Ontario, Canada
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Department of Nephrology and Hypertension, Rabin Medical Center, Petach-Tikva, Israel
| | - Junhui Zhao
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | - Brian Bieber
- Arbor Research Collaborative for Health, Ann Arbor, Michigan
| | | | - Laura Horowitz
- Division of Nephrology, McGill University Health Center, Montreal, Quebec, Canada
| | - Sharon J. Nessim
- Division of Nephrology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Beth Piraino
- Renal Electrolyte Division, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Mark Lambie
- School of Medicine, Keele University, Keele, Staffordshire, United Kingdom
| | - Talerngsak Kanjanabuch
- Division of Nephrology, Department of Medicine, and Center of Excellence in Kidney Metabolic Disorders, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yasuhiko Ito
- Department of Nephrology and Rheumatology, Aichi Medical University, Nagakute, Japan
| | - Neil Boudville
- Medical School, University of Western Australia, Perth, Australia
| | | | | | - Jeffrey Perl
- Department of Medicine, Division of Nephrology, St. Michael's Hospital and the Keenan Research Center in the Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
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The Prevalence of Helicobacter Pylori Infection in Patients with Chronic Kidney Disease Undergoing Hemodialysis. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2021. [DOI: 10.2478/sjecr-2021-0044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
The aim of this study was to analyze the prevalence of Helicobacter pylori infection and gastroduodenal lesions in Montenegrin patients with chronic kidney disease on hemodialysis. The study included 55 hemodialysis patients with dyspeptic symptoms and 50 control subjects with normal kidney function who had also dyspepsia. After dyspepsia assessment by an interview, all subjects underwent gastroduodenoscopy and histopathological analysis of biopsy specimens, taken from the corpus and antrum of the stomach. Helicobacter pylori was confirmed in 50.9% of corpus mucosa i.e. 60.6% of antrum mucosa of maintenance hemodialysis patients. There were no significantly differences in endoscopic findings of the stomach and bacterial presence between the two study groups of participants (p = 0.451), while duodenal lesions were prevalent in control subjects (p < 0.001). The atrophy of corpus mucosa was more common in hemodialysis patients (p = 0.007), especially in those who have been on hemodialysis for a longer time (p < 0.001) and had lower pH (p = 0.011). The prevalence of Helicobacter pylori infection shown an inverse relationship with dialysis duration. Contrary, a positive relationship between Helicobacter pylori and the concentration of bicarbonate was demonstrated (p = 0.031). The prevalence of Helicobacter pylori and atrophic mucosal changes in Montenegrin hemodialysis patients depends on dialysis duration and acid-base balance.
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Usta M, Ersoy A, Ayar Y, Ocakoğlu G, Yuzbasioglu B, Erdem ED, Erdogan O. Comparison of endoscopic and pathological findings of the upper gastrointestinal tract in transplant candidate patients undergoing hemodialysis or peritoneal dialysis treatment: a review of literature. BMC Nephrol 2020; 21:444. [PMID: 33092560 PMCID: PMC7583226 DOI: 10.1186/s12882-020-02108-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 10/14/2020] [Indexed: 01/10/2023] Open
Abstract
Background Dyspepsia is a common disorder in kidney transplant recipients, and the risk of post-transplant complications is increased in candidates with upper gastrointestinal disease. We evaluated gastrointestinal lesions of kidney transplant candidates on dialysis. Methods In this study, endoscopic and pathological findings in hemodialysis (HD) and peritoneal dialysis (PD) patients with gastrointestinal symptoms on the waiting list were compared. Results The most common non-ulcerous lesions in the endoscopic examination were gastritis (62.3%), erosive gastritis (38.7%), duodenal erosion or duodenitis (18.9%) and esophagitis (13.2%). The ulcerous lesion was present in only 3 patients. Gastroesophageal reflux disease, ulcerated lesion and non-ulcerated lesion rates were similar in both dialysis groups. Histopathological examination revealed Helicobacter pylori (HP) positivity in 28.3% of patients. HP positivity rate was significantly higher in PD patients than in HD patients (38.7% vs. 13.6%, p = 0.046). Chronic gastritis (75.5%) was the most common pathological finding. HP positivity rate was 37.5% in patients with chronic gastritis, but HP was negative in patients without chronic gastritis. In multivariate analysis, male gender, urea and albumin levels were associated with the presence of pathological chronic gastritis. The presence of gastritis, total cholesterol and ferritin levels were found significant for HP positivity. A total cholesterol > 243 mg/dL was significantly related to an increased risk of the presence of HP positivity. Conclusions Gastrointestinal lesions and HP infection are common in dialysis patients. Dialysis modality may affect the frequency of some lesions. It may be useful to have an endoscopic examination before entering the transplant waiting list for all candidates.
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Affiliation(s)
- Mehmet Usta
- Bursa City Hospital, Department of Nephrology, Nephrology Clinic, Dogankoy mevki, Nilufer, Bursa, Turkey
| | - Alparslan Ersoy
- Division of Nephrology, Department of Internal Medicine, Bursa Uludag University Faculty of Medicine, Gorukle, Nilufer, Bursa, Turkey
| | - Yavuz Ayar
- Bursa City Hospital, Department of Nephrology, Nephrology Clinic, Dogankoy mevki, Nilufer, Bursa, Turkey.
| | - Gökhan Ocakoğlu
- Faculty of Medicine, Department of Bioistatistics, Uludag University, Gorukle, Nilufer, Bursa, Turkey
| | - Bilgehan Yuzbasioglu
- Bursa State Hospital, Department of Gastroenterology, Gastroenterology Clinic, Osmangazi, Bursa, Turkey
| | - Emrullah Düzgün Erdem
- Bursa State Hospital, Department of Gastroenterology, Gastroenterology Clinic, Osmangazi, Bursa, Turkey
| | - Omer Erdogan
- Department of Pathology, Bursa City Hospital, Dogankoy mevki, Nilufer, Bursa, Turkey
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Turshudzhyan A, Inyangetor D. Uremic and Post-Transplant Gastropathy in Patients With Chronic Kidney Disease and End-Stage Renal Disease. Cureus 2020; 12:e10578. [PMID: 32983742 PMCID: PMC7510509 DOI: 10.7759/cureus.10578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Gastrointestinal (GI) mucosal lesions are common in chronic kidney disease (CKD), end-stage renal disease (ESRD), and in post-renal transplant period. However, etiology of mucosal lesions pre- and post-transplant is very different. Gastropathy in non-transplant ESRD patients usually develops because of uremia, chronic anemia, and fluctuations in the gastric blood supply during hemodialysis, eventually leading to uremic gastritis. Gastropathy in post-transplant patients tends to be associated with immunosuppressive therapies. Helicobacter pylori infection is more prevalent in uremic patients than in post-transplant patients. Uremia can also lead to uremic arteriolopathy and autonomic nervous system dysfunction, which can present with GI symptoms mimicking uremic gastropathy. Post-transplantation immunosuppressive therapies have been linked to GI mucosal lesions as well. These lesions carry a poor prognostic factor disrupting the function of the GI tract, which in turn affects the pharmacokinetics of the immunosuppressive drugs eventually leading to poor graft survival and increased mortality. Mycophenolate mofetil is one of the agents more associated with intestinal erosions. Recognizing uremic gastropathy and intervening early helps prevent post-transplant GI complications. Acid controlling therapies can be an effective prophylaxis against both gastropathies. Using enteric-coated formulation for immunosuppressive agents may slow down the mucosal insult. Treatment of H. pylori in both patient populations may help prevent further mucosal injury. Lastly, timely screening for symptoms may help start treatment early and prevent progression to serious gastropathy.
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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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Qiu L, Volk E, Mais DD. Histopathologic Patterns of Colitis in Patients With Impaired Renal Function. Am J Clin Pathol 2020; 153:380-386. [PMID: 31679016 DOI: 10.1093/ajcp/aqz176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES To characterize the histopathologic features of colitis in patients with impaired renal function. METHODS We retrospectively identified 413 patients who underwent colonoscopic evaluation for colitis between 2011 and 2015. Patients were divided into four groups based on estimated glomerular filtrate rates. Patients with impaired renal function were compared to overall and age-matched patients with normal renal function. RESULTS Compared to a preponderance of inflammatory bowel disease (33%) and lymphocytic colitis (9.6%) in patients with normal renal function, ischemic colitis (58%) was the predominant histopathologic pattern in the patients with impaired renal function. Infectious colitis was the second most common pattern (20.8%), with Clostridium difficile and cytomegalovirus infections being more frequent. Medication-induced injury was the third most common pattern, with crystal-associated injury being the exclusive pattern found in this study. CONCLUSIONS Colitis in patients with impaired renal function is etiologically distinct from that seen in patients with normal renal function.
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Affiliation(s)
- Lianqun Qiu
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio
| | - Emily Volk
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio
| | - Daniel D Mais
- Department of Pathology and Laboratory Medicine, University of Texas Health Science Center at San Antonio
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Niknam R, Barfei M, Mahmoudi L. Helicobacter pylori, Endoscopic, And Histologic Features Among Kidney Transplant Candidates In Southern Iran. Infect Drug Resist 2019; 12:3687-3693. [PMID: 31819550 PMCID: PMC6890516 DOI: 10.2147/idr.s228026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/06/2019] [Indexed: 12/14/2022] Open
Abstract
Background The risks of gastrointestinal disorders and cancer are higher in chronic kidney disease (CKD) patients than the general population. There are only a few published reports on the association of helicobacter pylori (H. pylori) infection, endoscopic findings, and histology in these patients. This study was designed to address these controversial topics among kidney transplant candidates as the first study in southern Iran. Patients and methods In this cross-sectional study, patients undergoing renal transplantation in the largest center of southern Iran during 2016–2017 were evaluated for the frequency of H. pylori infection, endoscopic findings, and histology. Gastric endoscopic findings (normal, abnormal non-ulcerative, ulcerative) and histological findings of gastric biopsy (normal/non-significant, inflammation, premalignant lesions (PMLs), malignant lesions) were studied. Results In total, 293 patients underwent endoscopy for transplant work up. The mean age (SD) was 47.37 (13.14) years. The most common endoscopic finding was abnormal gastric lesions. Overall, 78.8% patients had abnormal gastric histologic findings, of which 6.1% had PMLs. There was no significant association between laboratory data of patients with H. pylori infection. Of these, 147 (50.2%) patients were positive and the others were H. Pylori negative. Positive H. pylori infection was significantly associated with gastric ulcerative lesions. Positive H. pylori infection was also strongly associated with inflammation (P<0.01), but not significantly associated with PMLs (P=0.99) in gastric histology. Conclusion The present study showed that abnormal endoscopic and histologic findings as well as positive H. pylori infection were observed in a large number of kidney transplant candidates, so upper endoscopy with biopsy is an acceptable procedure for these patients. However, further studies are recommended to determine the relationship of H. pylori with abnormal endoscopic and histologic findings considering other confounding factors in kidney transplant candidates as well as the efficacy of H. pylori eradication therapy to improve these abnormal findings.
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Affiliation(s)
- Ramin Niknam
- Gastroenterohepatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Barfei
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Laleh Mahmoudi
- Department of Clinical Pharmacy, School of Pharmacy, Shiraz University of Medical Sciences, Shiraz, Iran
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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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Li KJ, Chen L. Association between duration of dialysis and Helicobacter pylori infection in dialysis patients: a meta-analysis. Int Urol Nephrol 2019; 51:1361-1370. [PMID: 31214954 DOI: 10.1007/s11255-019-02205-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 06/12/2019] [Indexed: 12/11/2022]
Abstract
PURPOSE The association between Helicobacter pylori (HP) infection and duration of dialysis in dialysis patients is conflicting, this meta-analysis was conducted to elucidate the association between duration of dialysis and HP infection status in dialysis patients, and subgroup study was conducted to explore its influencing factors. Furthermore, our study aims to provide advice on the treatment of dialysis patients. METHODS Articles published up to 30 September 2018 were searched from PubMed, Embase, Sinomed, Medline, China Knowledge Resource Integrated Database (CNKI) and Wang fang database. Two researchers independently identified whether studies met the eligibility criteria. The adjusted relative risk (RR) or the weighted mean difference (WMD) and their 95% CI were estimated. I2 was performed to evaluate the statistical heterogeneity. Publication bias was evaluated using Egger's test and a funnel plot. RESULTS Fourteen studies were included involving 2087 dialysis patients, 815 of them were HP positive, 1272 of them were HP negative. Quantitative data and qualitative data were analyzed, respectively. For quantitative data, statistical differences were observed in the association between HP infection and duration of dialysis (P = 0.008), also in the hemodialysis subgroup (P = 0.006). After stratifying by detection methods, differences still existed in groups with different detection methods (P = 0.001, P = 0.033). For qualitative data, there was no statistical difference in the association between HP infection rate and duration of dialysis (P = 0.295). Furthermore, we found that the age was higher in HP positive patients than in HP negative patients (P < 0.001). CONCLUSION Our meta-analysis found that HP infection rate was negatively correlated with accumulative dialysis time, and methods of HP detection did not influence the association between HP infection and accumulative dialysis time. We also found that age was the risk factor of HP infection in dialysis patients. Further studies need to be performed to elucidate the mechanism of the correlation between HP infection and duration of dialysis, to explore which timing period of dialysis is most susceptible to HP infection, then, improve the prognosis of patients with renal diseases.
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Affiliation(s)
- Kang-Jie Li
- School of Public Health and Management, Chongqing Medical University, Jin-Yun Campus, Huxi Town, Shapingba District, Chongqing, 400016, China
| | - Ling Chen
- The Center of Experimental Teaching Management, Chongqing Medical University, Chongqing, 401331, China.
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12
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Zhong HJ, Lin D, Lu ZY, Yang WY, Chen Y. Use of gastric-acid suppressants may be a risk factor for enteric peritonitis in patients undergoing peritoneal dialysis: A meta-analysis. J Clin Pharm Ther 2019; 44:209-215. [PMID: 30332507 DOI: 10.1111/jcpt.12769] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 08/23/2018] [Accepted: 09/13/2018] [Indexed: 12/14/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Mounting evidence suggests that long-term use of gastric-acid suppressants (GASs) may be associated with adverse effects. Whether GAS use increases the risk of enteric peritonitis in patients undergoing peritoneal dialysis (PD) is not known. The aim of this meta-analysis was to evaluate the association between GAS use and enteric peritonitis in PD patients. METHODS We searched PubMed, Embase and Cochrane Library databases from inception to 23 January 2018 to identify eligible studies. The primary outcome was an association between GAS use and enteric peritonitis in PD patients. RESULTS AND DISCUSSION Six studies involving 829 people were included in this meta-analysis. Pooled data showed that GAS use in PD patients was associated with an increased risk of enteric peritonitis (odds ratio [OR] = 1.27; 95% confidence interval [CI]: 1.02-1.57, I2 = 48%). Subgroup analyses based on GAS type revealed that histamine-2 receptor antagonists (H2 RAs) might increase the risk of enteric peritonitis in PD patients (OR = 1.40; 95% CI: 1.01-1.93; I2 = 8%), but proton pump inhibitors (PPIs) might not (1.13; 0.72-1.77; 6; 34%). WHAT IS NEW AND CONCLUSION Gastric-acid suppressants use might be a risk factor for enteric peritonitis in PD patients. In particular, H2 RAs increased the risk of enteric peritonitis, but PPIs did not. Therefore, to prevent enteric peritonitis, H2 RAs should probably be prescribed with caution for PD patients.
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Affiliation(s)
- Hao-Jie Zhong
- Department of Gastroenterology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangdong, China
- Guangdong Medical University, Guangdong, China
| | - Da Lin
- Department of Gastroenterology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangdong, China
| | - Zhi-Yong Lu
- Department of Dermatology, Qingyuan Hospital of Traditional Chinese Medicine, Guangdong, China
| | | | - Yu Chen
- Department of Gastroenterology, The First Affiliated Hospital of Guangdong Pharmaceutical University, Guangdong, China
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Sahara S, Sugimoto M, Ichikawa H, Kagami T, Sakao Y, Ohashi N, Horio Y, Sugimoto K, Kato A, Furuta T, Yasuda H. Efficacy of Reduced Dosage of Amoxicillin in an Eradication Therapy for Helicobacter pylori Infection in Patients on Hemodialysis: A Randomized Controlled Trial. Digestion 2018; 97:163-169. [PMID: 29310119 DOI: 10.1159/000484981] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 11/04/2017] [Indexed: 02/04/2023]
Abstract
BACKGROUND An optimum Helicobacter pylori-eradication regimen for hemodialysis patients is yet to be established because of different pharmacokinetics of amoxicillin involved between hemodialysis patients and healthy subjects. We investigated to establish appropriate doses of amoxicillin for H. pylori infection eradication in hemodialysis patients. METHODS Of 409 hemodialysis patients screened for H. pylori infection, 37 H. pylori-positive patients were randomized to different 1-week eradication regimens: esomeprazole 20 mg twice a day (b.i.d.) and clarithromycin 200 mg b.i.d., plus amoxicillin at either 750 mg b.i.d. (group A; conventional) or 250 mg b.i.d. (group B; experimental). Sixty-three patients with normal renal function received the conventional regimen (group C). Successful eradication was confirmed by urea breath testing. RESULTS Eradication rates of group B (reduced amoxicillin-regimen) were 84.2% in intention-to-treat analysis and 88.9% in per-protocol analysis, which were similar with group A (77.8 and 77.8%) and group C (74.6 and 81.0%). However, the incidence of adverse events in group A was significantly higher than that in group C (22.2 vs. 5.1%, p = 0.027). CONCLUSIONS In H. pylori-positive hemodialysis patients, amoxicillin at 250 mg b.i.d. may be an appropriate scheme for eradication with equivalent effects to the conventional therapy and safety effects for adverse events.
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Affiliation(s)
- Shu Sahara
- First Department of Medicine, Hamamatsu, Japan
| | - Mitsushige Sugimoto
- First Department of Medicine, Hamamatsu, Japan.,Division of Digestive Endoscopy, Shiga University of Medical Science Hospital, Otsu, Japan
| | | | | | | | - Naro Ohashi
- First Department of Medicine, Hamamatsu, Japan
| | - Yoshiaki Horio
- Department of Gastroenterology, Municipal Kosai Hospital, Kosai, Japan
| | | | | | - Takahisa Furuta
- Center for Clinical Research, Hamamatsu University School of Medicine, Hamamatsu, Japan
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García Agudo R, Aoufi Rabih S, González Carro P, Pérez Roldán F, Proy Vega B, Arias Arias Á, Cazalla Cadenas F, Tenías Burillo JM, Fernández Rodríguez A. Gastrointestinal lesions in chronic kidney disease patients with anaemia. Nefrologia 2018; 39:50-57. [PMID: 30153940 DOI: 10.1016/j.nefro.2018.05.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 03/15/2018] [Accepted: 05/03/2018] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Despite the frequency with which anaemia is present in patients with chronic kidney disease (CKD), its relationship with gastrointestinal lesions has not been studied. METHOD A cross-sectional, analytical, observational study involving one year of recruitment was carried out to determine the prevalence of endoscopic gastrointestinal lesions and associated risk factors in asymptomatic patients with chronic kidney disease stages 1-5 and anaemia who had a positive qualitative immunochemical faecal occult blood test. RESULTS A total of 9,658 patients with CKD were analysed, of which 286 (2.9%) had anaemia; 198 had a positive faecal occult blood test (47% male, 71.1±11.8 years). The endoscopic study revealed 255 lesions, with at least one lesion in 68.2% of patients, with the most prevalent being: adenomatous colorectal polyps (39.6%), acute lesions of the gastric mucosa (22.6%), neoplastic lesions 15.1%), angiodysplasia (14.4%), oesophagitis (8.4%), inflammatory bowel disease (4.8%) and ischaemic colitis (3.1%). Uraemia and acetylsalicylic acid were identified as risk factors for acute gastric mucosal lesions. Angiodysplasia was associated with alcoholism, a more advanced stage of chronic kidney disease, anaemia, and lack of response to erythropoiesis-stimulating agents. Age and refractory anaemia were risk factors for adenomatous polyps and colorectal cancer. CONCLUSION Renal patients with anaemia could benefit from an endoscopic study due to their high prevalence of gastrointestinal lesions, particularly adenomatous polyps and colorectal cancer, which are more common in those over 50 years of age with CKD stages 3-5.
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Affiliation(s)
- Rebeca García Agudo
- Servicio de Nefrología, Hospital La Mancha-Centro, Alcázar de San Juan, Ciudad Real, España; Departamento de Citología e Histología Normal y Patológica, Facultad de Medicina, Universidad de Sevilla, Sevilla, España.
| | - Sami Aoufi Rabih
- Servicio de Aparato Digestivo, Hospital La Mancha-Centro, Alcázar de San Juan, Ciudad Real, España; Departamento de Citología e Histología Normal y Patológica, Facultad de Medicina, Universidad de Sevilla, Sevilla, España
| | - Pedro González Carro
- Servicio de Aparato Digestivo, Hospital La Mancha-Centro, Alcázar de San Juan, Ciudad Real, España
| | - Francisco Pérez Roldán
- Servicio de Aparato Digestivo, Hospital La Mancha-Centro, Alcázar de San Juan, Ciudad Real, España
| | - Beatriz Proy Vega
- Servicio de Farmacia Hospitalaria, Hospital La Mancha-Centro, Alcázar de San Juan, Ciudad Real, España
| | - Ángel Arias Arias
- Unidad de Apoyo a la Investigación, Hospital La Mancha-Centro, Alcázar de San Juan, Ciudad Real, España
| | - Fátima Cazalla Cadenas
- Servicio de Nefrología, Hospital La Mancha-Centro, Alcázar de San Juan, Ciudad Real, España
| | - José María Tenías Burillo
- Unidad de Apoyo a la Investigación, Hospital La Mancha-Centro, Alcázar de San Juan, Ciudad Real, España
| | - Ana Fernández Rodríguez
- Departamento de Citología e Histología Normal y Patológica, Facultad de Medicina, Universidad de Sevilla, Sevilla, España
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Waszczuk-Gajda A, Lewandowski Z, Drozd-Sokołowska J, Boguradzki P, Dybko J, Wróbel T, Basak GW, Jurczyszyn A, Mądry K, Snarski E, Frączak E, Charliński G, Feliksbrot-Bratosiewicz M, Król M, Matuszkiewicz-Rowińska J, Klinger M, Krajewska M, Augustyniak-Bartosik H, Kościelska M, Rusicka P, Dwilewicz-Trojaczek J, Wiktor Jędrzejczak W. Autologous peripheral blood stem cell transplantation in dialysis-dependent multiple myeloma patients-DAUTOS Study of the Polish Myeloma Study Group. Eur J Haematol 2018; 101:475-485. [DOI: 10.1111/ejh.13101] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2018] [Indexed: 12/21/2022]
Affiliation(s)
- Anna Waszczuk-Gajda
- Department of Haematology, Oncology and Internal Diseases; Warsaw Medical University; Warsaw Poland
| | - Zbigniew Lewandowski
- Department of Epidemiology and Biostatistics; Warsaw Medical University; Warsaw Poland
| | - Joanna Drozd-Sokołowska
- Department of Haematology, Oncology and Internal Diseases; Warsaw Medical University; Warsaw Poland
| | - Piotr Boguradzki
- Department of Haematology, Oncology and Internal Diseases; Warsaw Medical University; Warsaw Poland
| | - Jarosław Dybko
- Department and Clinic of Haematology, Blood Neoplasms and Bone Marrow Transplantation; Wroclaw Medical University; Warsaw Poland
| | - Tomasz Wróbel
- Department and Clinic of Haematology, Blood Neoplasms and Bone Marrow Transplantation; Wroclaw Medical University; Warsaw Poland
| | - Grzegorz Władysław Basak
- Department of Haematology, Oncology and Internal Diseases; Warsaw Medical University; Warsaw Poland
| | - Artur Jurczyszyn
- Department of Haematology; Jagiellonian University; Kraków Poland
| | - Krzysztof Mądry
- Department of Haematology, Oncology and Internal Diseases; Warsaw Medical University; Warsaw Poland
| | - Emilian Snarski
- Department of Haematology, Oncology and Internal Diseases; Warsaw Medical University; Warsaw Poland
| | - Ewa Frączak
- Department and Clinic of Haematology, Blood Neoplasms and Bone Marrow Transplantation; Wroclaw Medical University; Warsaw Poland
| | - Grzegorz Charliński
- Department of Haematology, Oncology and Internal Diseases; Warsaw Medical University; Warsaw Poland
- Department of Haematology; Nicolaus Copernicus Specialist Municipal Hospital; Toruń Poland
| | | | - Małgorzata Król
- Department of Haematology, Oncology and Internal Diseases; Warsaw Medical University; Warsaw Poland
| | | | - Marian Klinger
- Department of Nephrology and Transplantation Medicine; Wroclaw Medical University; Wrocław Poland
| | - Magdalena Krajewska
- Department of Nephrology and Transplantation Medicine; Wroclaw Medical University; Wrocław Poland
| | | | - Małgorzata Kościelska
- Department of Nephrology and Internal Diseases; Medical University of Warsaw; Warsaw Poland
| | - Patrycja Rusicka
- Department of Haematology, Oncology and Internal Diseases; Warsaw Medical University; Warsaw Poland
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Sugimoto M, Yasuda H, Andoh A. Nutrition status and Helicobacter pylori infection in patients receiving hemodialysis. World J Gastroenterol 2018; 24:1591-1600. [PMID: 29686466 PMCID: PMC5910542 DOI: 10.3748/wjg.v24.i15.1591] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 03/18/2018] [Accepted: 03/25/2018] [Indexed: 02/06/2023] Open
Abstract
Chronic kidney disease (CKD) patients receiving hemodialysis (HD) often develop gastrointestinal abnormalities over their long treatment period. In general, prognosis in such patients is poor due to the development of protein-energy wasting (PEW). Therefore, it is important to clarify the etiology of PEW and to establish better strategies to deal with this condition. Chronic Helicobacter pylori (H. pylori) infection in the gastric mucosa has a close association with not only the development of peptic ulcer disease and gastric cancer, but is also associated with abnormal plasma and gastric mucosal ghrelin levels that are seen in malnutrition. It is unclear whether H. pylori infection of the gastric mucosa is directly associated with prognosis in HD patients by affecting ghrelin levels. Recent studies show that the prevalence of H. pylori infection in HD patients is significantly lower than in subjects with normal renal function. In the natural history of H. pylori infection in HD patients, the prevalence of infection decreases as the length of time on HD increases. The severity of gastric mucosal atrophy has been suggested as the major determinant of ghrelin levels in these patients, and eradication therapy of H. pylori improves nutritional status by increasing serum cholinesterase and cholesterol levels, especially in patients with mild-to-moderate gastric mucosal atrophy. Prompt H. pylori eradication to inhibit the progress of gastric atrophy may be required to prevent this decrease in ghrelin levels and subsequent PEW and improve the prognosis of HD patients by improving their nutritional status.
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Affiliation(s)
- Mitsushige Sugimoto
- Division of Digestive Endoscopy, Shiga University of Medical Science Hospital, Shiga 520-2192, Japan
| | - Hideo Yasuda
- First Department of Medicine, Hamamatsu University School of Medicine, Shizuoka 431-3192, Japan
| | - Akira Andoh
- Department of Gastroenterology, Shiga University of Medical Science Hospital, Shiga 520-2192, Japan
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17
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Sugimoto M, Sahara S, Ichikawa H, Sakao Y, Ohashi N, Sugimoto K, Yasuda H, Furuta T, Andoh A. Natural Course of Helicobacter pylori Infection in Japanese Hemodialysis Patients. Digestion 2018; 95:302-309. [PMID: 28521319 DOI: 10.1159/000475659] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Accepted: 04/10/2017] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Helicobacter pylori (H. pylori) infection is one of the major risk factors for gastrointestinal morbidity in hemodialysis patients. Primary end point is to investigate H. pylori infection rate in hemodialysis patients. As secondary end point, we clarified whether pepsinogen (PG) level was related with H. pylori infection status in hemodialysis patients. METHODS Serum levels of PG I, II, and anti-H. pylori IgG antibody were assessed in 500 Japanese hemodialysis patients. RESULTS H. pylori infection rate was 15.0% (75/500; 95% CI 12.0-18.4). The duration of hemodialysis in H. pylori-positives was 4.6 ± 3.8 years, which was significantly shorter than in H. pylori-negatives (7.3 ± 6.9, p = 0.001). PG I levels positively correlated with the PG II level and PG I/II ratio (|R| = 0.661, p < 0.001, and |R| = 0.544, p <0.001, respectively). Using a cutoff value of 7.75, the sensitivity and specificity of PG I/II ratio for predicting H. pylori-negatives were 86.3 and 87.8%, respectively (area under the curve 0.930). CONCLUSIONS In hemodialysis patients, infection rate with H. pylori was <20%, with lower rates in patients receiving hemodialysis for longer terms. A PG I/II ratio with a cutoff value of 7.75 may be useful for screening for H. pylori status.
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Affiliation(s)
- Mitsushige Sugimoto
- Division of Digestive Endoscopy, Shiga University of Medical Science Hospital, Otsu, Shiga, Japan
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18
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Hágendorn R, Farkas N, Vincze Á, Gyöngyi Z, Csupor D, Bajor J, Erőss B, Csécsei P, Vasas A, Szakács Z, Szapáry L, Hegyi P, Mikó A. Chronic kidney disease severely deteriorates the outcome of gastrointestinal bleeding: A meta-analysis. World J Gastroenterol 2017; 23:8415-8425. [PMID: 29308001 PMCID: PMC5743512 DOI: 10.3748/wjg.v23.i47.8415] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 11/23/2017] [Accepted: 12/04/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To understand the influence of chronic kidney disease (CKD) on mortality, need for transfusion and rebleeding in gastrointestinal (GI) bleeding patients. METHODS A systematic search was conducted in three databases for studies on GI bleeding patients with CKD or end-stage renal disease (ESRD) with data on outcomes of mortality, transfusion requirement, rebleeding rate and length of hospitalization (LOH). Calculations were performed with Comprehensive Meta-Analysis software using the random effects model. Heterogeneity was tested by using Cochrane's Q and I2 statistics. Mean difference (MD) and OR (odds ratio) were calculated. RESULTS 1063 articles (EMBASE: 589; PubMed: 459; Cochrane: 15) were found in total. 5 retrospective articles and 1 prospective study were available for analysis. These 6 articles contained data on 406035 patients, of whom 51315 had impaired renal function. The analysis showed a higher mortality in the CKD group (OR = 1.786, 95%CI: 1.689-1.888, P < 0.001) and the ESRD group (OR = 2.530, 95%CI: 1.386-4.616, P = 0.002), and a rebleeding rate (OR = 2.510, 95%CI: 1.521-4.144, P < 0.001) in patients with impaired renal function. CKD patients required more unit red blood cell transfusion (MD = 1.863, 95%CI: 0.812-2.915, P < 0.001) and spent more time in hospital (MD = 13.245, 95%CI: 6.886-19.623, P < 0.001) than the controls. CONCLUSION ESRD increases mortality, need for transfusion, rebleeding rate and LOH among GI bleeding patients. Prospective patient registries and observational clinical trials are crucially needed.
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Affiliation(s)
- Roland Hágendorn
- Department of Gastroenterology, First Department of Medicine, University of Pécs, Pécs 7624, Hungary
| | - Nelli Farkas
- Institute of Bioanalysis, University of Pécs, Pécs 7624, Hungary
| | - Áron Vincze
- Department of Gastroenterology, First Department of Medicine, University of Pécs, Pécs 7624, Hungary
| | - Zoltán Gyöngyi
- Department of Public Health Medicine, University of Pécs, Pécs 7624, Hungary
| | - Dezső Csupor
- Department of Pharmacognosy, Faculty of Pharmacy, University of Szeged, Szeged 6720, Hungary
| | - Judit Bajor
- Department of Gastroenterology, First Department of Medicine, University of Pécs, Pécs 7624, Hungary
| | - Bálint Erőss
- Institute for Translational Medicine, University of Pécs, Pécs 7624, Hungary
| | - Péter Csécsei
- Department of Neurology, University of Pécs, Pécs 7623, Hungary
| | - Andrea Vasas
- Department of Pharmacognosy, Faculty of Pharmacy, University of Szeged, Szeged 6720, Hungary
| | - Zsolt Szakács
- Institute for Translational Medicine, University of Pécs, Pécs 7624, Hungary
| | - László Szapáry
- Institute for Translational Medicine, University of Pécs, Pécs 7624, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, University of Pécs, Pécs 7624, Hungary
| | - Alexandra Mikó
- Institute for Translational Medicine, University of Pécs, Pécs 7624, Hungary
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Abstract
Introduction Renal transplantation is the definitive treatment for end stage renal disease. Patients subjected to transplantation require lifelong immunosuppression and are prone to several gastrointestinal disorders. Dyspepsia is a common disorder in these patients. The objective of this study was to determine factors leading to dyspepsia in renal (kidney) transplant recipients. Methods It was a cross sectional study conducted at department of hepatogastroenterology and transplant sciences, SIUT Karachi, from 1-6-15 to 1-12-15 for six months. All renal transplanted patients having dyspeptic symptoms for more than 6 weeks. EGD was performed, biopsy specimens obtained from antrum and duodenum, these were sent for histopathological examination. Frequency and percentages were obtained for categorical variables, mean ± SD was calculated for continuous variables. Chi square test was used for categorical variable and student t-test for continuous variables. Results Ninety patients were included in the study out of which 64 (71.1%) were males, mean age was 35.82 ± 10.04 years (range: 18-65 years). Gastritis (non H.pylori associated) in 78 (78.6%), duodenitis in 35 (38.9%) and H. pylori infection in 29 (32.2%), renal transplant recipients. Most of the patients belonged to Sindhi ethnicity, 27 (30%), followed by Punjabi. Hypertension was the most common co-morbid condition in our patients found in 29 (32.2%), while most of them don't have any co morbid condition. Duodenitis was found to be associated with tacrolimus use (p = 0.037). Conclusion Gastritis is the most common factor accountable for this symptoms, followed by duodenitis and H. Pylori. Patients taking tacrolimus as immunosuppressant are more prone to develop duodenitis.
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Affiliation(s)
- Aisha Nazeer
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi
| | - Ayesha Aslam Rai
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi
| | - Nasir Hassan Luck
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi
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Cheungpasitporn W, Thongprayoon C, Wijarnpreecha K, Mitema DG, Mao MA, Nissaisorakarn P, Podboy A, Kittanamongkolchai W, Sakhuja A, Erickson SB. Decline in prevalence and risk of helicobacter pylori in kidney transplant recipients: A systematic review and meta-analysis. J Evid Based Med 2017; 10:171-176. [PMID: 28464553 DOI: 10.1111/jebm.12252] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 02/13/2017] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The study's aims were (1) to investigate the prevalence and (2) to assess the risk of Helicobacter pylori (H. pylori) infection in kidney transplant recipients. METHODS A comprehensive literature search was performed from inception until September 2016. Studies that reported prevalence, relative risks, odd ratios, or hazard ratios of H. pylori among kidney transplant recipients were included. Pooled risk ratios and 95% CI were calculated using a random-effect model. RESULTS Eleven observational studies with 2545 kidney transplant recipients were enrolled. Between year 1990 and 2000, the estimated prevalence of H. pylori among people with kidney transplant was 50% (95% CI: 31% to 68%), with a prevalence of 46% (95% CI: 23% to 70%) in high-income countries and 55% (95% CI: 22% to 86%) in middle-income countries, respectively. From year 2000 to 2016, the estimated prevalence of H. pylori among people with kidney transplant was 35% (95% CI: 26% to 45%), with a prevalence of 28% (95% CI: 19% to 37%) in high-income countries and 45% (95% CI: 38% to 51%) in middle-income countries. Data regarding prevalence of H. pylori infection in low-income countries were limited. The pooled RR of H. pylori in kidney transplant recipients was 0.57 (95% CI: 0.33 to 1.00) when compared to people with non-transplant. CONCLUSIONS There has been a decline in prevalence of H. pylori in kidney transplant recipients with the overall estimated prevalence of H. pylori in kidney transplant recipients of 35%, particularly in both high-income and middle-income countries. Also, our meta-analysis demonstrates a potential decreased risk of H. pylori infection in kidney transplant recipients compared with non-transplant populations.
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Affiliation(s)
| | - Charat Thongprayoon
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, New York, USA
| | - Karn Wijarnpreecha
- Department of Internal Medicine, Bassett Medical Center, Cooperstown, New York, USA
| | - Donald G Mitema
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael A Mao
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
| | - Pitchaphon Nissaisorakarn
- Department of Internal Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Alexander Podboy
- Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Ankit Sakhuja
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA
- Division of Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Stephen B Erickson
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, 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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Alirezaei A, Movassagh Koolankuh S, Talaie R, Azmoodeh S, Bakhtiyari M. Association of Helicobacter pylori specific IgG antibody with serum magnesium levels in peritoneal dialysis patients. J Nephropharmacol 2017. [DOI: 10.15171/npj.2017.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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23
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Wijarnpreecha K, Thongprayoon C, Nissaisorakarn P, Lekuthai N, Jaruvongvanich V, Nakkala K, Rajapakse R, Cheungpasitporn W. Association between Helicobacter pylori and end-stage renal disease: A meta-analysis. World J Gastroenterol 2017; 23:1497-1506. [PMID: 28293097 PMCID: PMC5330835 DOI: 10.3748/wjg.v23.i8.1497] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2016] [Revised: 12/09/2016] [Accepted: 01/18/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the prevalence and association of Helicobacter pylori (H. pylori) with end-stage renal disease (ESRD).
METHODS SA comprehensive literature search was completed from inception until October 2016. Studies that reported prevalence, relative risks, odd ratios, hazard ratios or standardized incidence ratio of H. pylori among ESRD patients were included. Participants without H. pylori were used as comparators to assess the association between H. pylori infection and ESRD. Pooled risk ratios and 95%CI was calculated using a random-effect model. Adjusted point estimates from each study were combined by the generic inverse variance method of DerSimonian and Laird.
RESULTS Of 4546 relevant studies, thirty-seven observational studies met all inclusion criteria. Thirty-five cross-sectional studies were included in the analyses to assess the prevalence and association of H. pylori with ESRD. The estimated prevalence of H. pylori among ESRD patients was 44% (95%CI: 40%-49%). The pooled RR of H. pylori in patients with ESRD was 0.77 (95%CI: 0.59-1.00) when compared with the patients without ESRD. Subgroup analysis showed significantly reduced risk of H. pylori in adult ESRD patients with pooled RR of 0.71 (95%CI: 0.55-0.94). The data on the risk of ESRD in patients with H. pylori were limited. Two cohort studies were included to assess the risk of ESRD in patients with H. pylori. The pooled risk RR of ESRD in patients with H. pylori was 0.61 (95%CI: 0.03-12.20).
CONCLUSION The estimated prevalence of H. pylori in ESRD patients is 44%. Our meta-analysis demonstrates a decreased risk of H. pylori in adult ESRD patients.
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Hsu CH, Hu HY, Huang N, Chang SS. Early eradication has a lower risk of peptic ulcer bleeding in Helicobacter pylori-infected chronic kidney disease patients. Eur J Intern Med 2016; 33:112-7. [PMID: 27449117 DOI: 10.1016/j.ejim.2016.06.035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 06/29/2016] [Accepted: 06/29/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND End stage renal disease (ESRD) contributes to a higher mortality rate in peptic ulcer bleeding (PUB) patients. A crucial question is whether early Helicobacter pylori (H. pylori) eradication therapy is necessary for H. pylori-infected chronic kidney disease (CKD) patients. To explore whether H. pylori eradication therapy has a lower risk of PUB at the pre-ESRD stage than at the ESRD stage. METHODS AND PATIENTS Patients meeting 2 criteria were defined as newly diagnosed ESRD cases: (1) patients diagnosed with ESRD and receiving regular dialysis between 2000 and 2009; and (2) patients with no history of dialysis between 1997 and 1999. We divided the study participants into pre-ESRD and ESRD groups on the basis of the time between H. pylori eradication and dialysis. The date of the first PUB diagnosis was defined as the primary endpoint. Stratified Cox proportional hazard regression analysis was used to estimate the effect of H. pylori eradication at the pre-ESRD and ESRD stage on the occurrence of PUB. RESULTS We included 476 patients in the pre-ESRD cohort and 476 patients in the matched ESRD cohort. After adjustment for age, sex, the presence of comorbidities, and medication use, the hazard ratio of PUB was 0.66 times less in the pre-ESRD cohort than in the ESRD cohort. Factors such as Charlson's score more than 3, and nonsteroidal anti-inflammatory drugs were associated with an increased risk of PUB. CONCLUSION Our result supports that early H. pylori eradication has a lower risk of PUB in H. pylori-infected CKD patients.
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Affiliation(s)
- Ching-Hui Hsu
- Division of Allergy, Immunology, Rheumatology, Taipei City Hospital Yang-Ming Branch, Taiwan; Department of Internal Medicine, Taipei City Hospital Yang-Ming Branch, Taiwan
| | - Hsiao-Yun Hu
- Institute of Public Health and Department of Public Health, National Yang-Ming University, Taiwan; Department of Education and Research, Taipei City Hospital, Taiwan
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taiwan
| | - Shen-Shong Chang
- Division of Gastroenterology, Taipei City Hospital Yang-Ming Branch, Taiwan; Department of Internal Medicine, Taipei City Hospital Yang-Ming Branch, Taiwan; School of Medicine, National Yang-Ming University, Taiwan; Institute of Public Health and Department of Public Health, National Yang-Ming University, Taiwan.
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Makhlough A, Fakheri H, Hojati S, Hosseini V, Bari Z. A Comparison between Hybrid Therapy and Standard Triple Therapy for Helicobacter pylori Eradication in Patients with Uremia: A Randomized Clinical Trial. Middle East J Dig Dis 2016; 8:39-43. [PMID: 26933480 PMCID: PMC4773081 DOI: 10.15171/mejdd.2016.05] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND
The prevalence of peptic ulcer disease in hemodialysis patients is more than the general population. They are also more prone to complications including upper gastrointestinal bleeding. The aim of this study was to compare the efficacy of 14 days hybrid regimen with 14 days triple therapy for Helicobacter pylori (H. pylori ) eradication in hemodialysis patients.
METHODS
Forty hemodialysis patients with naïve H.pylori infection were randomized to receive either hybrid regimen (pantoprazole 40 mg + amoxicillin 500 mg, both twice a day during the first 7 days, followed by pantoprazole 40 mg + amoxicillin 500 mg + clarithromycin 500 mg + tinidazole 500 mg, all twice a day, for the second 7 days, or standard triple therapy including pantoprazole 40 mg, clarithromycin 500 mg, and amoxicillin 500 mg, all twice a day for 14 days. H.pylori eradication was assessed by fecal H.pylori antigen test 8 weeks after the treatment.
RESULTS
All the patients completed the study. According to both intention to treat and per-protocol analyses, H.pylori eradication rates were 100% (95% confidence interval (CI): 100) in those who received hybrid therapy and 70% (95% CI: 69.4 – 70.8) in those who were treated by standard triple therapy (p=0.02). Severe adverse effects were not reported by any patient; however, mild adverse effects were more frequent in those who received standard triple therapy (p<0.05).
CONCLUSION
Hybrid regimen could achieve ideal H.pylori eradication rates with low rates of adverse effects.
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Affiliation(s)
- Atieh Makhlough
- Associate Professor, Department of Nephrology, Gut and Liver Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Hafez Fakheri
- Professor, Department of Gastroenterology, Gut and Liver Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Samaneh Hojati
- Resident of Internal Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Vahid Hosseini
- Associate Professor, Department of Gastroenterology, Gut and Liver Research Center, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zohreh Bari
- Fellow of Gastroenterology, Mazandaran University of Medical Sciences, Sari, Iran
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Seroprevalence of Helicobacter pylori Infection in Renal Transplant Recipient Attending Duhok Kidney Disease Center. Transplant Proc 2016; 48:92-5. [DOI: 10.1016/j.transproceed.2016.01.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Revised: 12/23/2015] [Accepted: 01/05/2016] [Indexed: 01/25/2023]
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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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Sood MM, Garg AX, Bota SE, Marisiddappa L, McArthur E, Naylor KL, Kapral MK, Kim SJ, Lam NN, Molnar AO, Harel Z, Perl J, Knoll GA. Risk of major hemorrhage after kidney transplantation. Am J Nephrol 2015; 41:73-80. [PMID: 25677869 DOI: 10.1159/000371902] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 01/02/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Major hemorrhagic events are associated with significant morbidity and mortality. We examined the three-year cumulative incidence of hospitalization with major nontraumatic hemorrhage after kidney transplantation. METHODS We performed a retrospective cohort study using healthcare administrative data of all adult-incident kidney-only transplantation recipients in Ontario, Canada from 1994 to 2009. We calculated the three-year cumulative incidence, event rate, and incident rate ratio of hospitalization with major hemorrhage, its subtypes and those undergoing a hemorrhage-related procedure. RESULTS were stratified by patient age and donor type and compared to a random and propensity-score matched sample from the general population. RESULTS Among 4,958 kidney transplant recipients, the three-year cumulative incidence of hospitalization with nontraumatic major hemorrhage was 3.5% (95% confidence interval [CI] 3.0-4.1%, 12.7 events per 1,000 patient-years) compared to 0.4% (95% CI 0.4-0.5%) in the general population (RR = 8.2, 95% CI 6.9-9.7). The crude risk of hemorrhage was 3-9-fold higher in all subtypes (upper/lower gastrointestinal, intra-cranial) and 15-fold higher for gastrointestinal endoscopic procedures compared to the random sample from the general population. After propensity score matching, the relative risk for major hemorrhage and its subtypes attenuated but remained elevated. The cumulative incidence of hemorrhage was higher for older individuals and those with a deceased donor kidney. CONCLUSION Kidney transplantation recipients have a higher risk of hospitalization with hemorrhage compared to the general population, with about 1 in 30 recipients experiencing a major hemorrhage in the three years following transplant.
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Affiliation(s)
- Manish M Sood
- Division of Nephrology, University of Ottawa, Ottawa Hospital Research Institute, Ottawa, Ont., Canada
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Makhlough A, Fakheri H, Farkhani AR, Seddighi O, Hossieni SV, Khademloo M, Bari Z. A comparison between standard triple therapy and sequential therapy on eradication of Helicobacter pylori in uremic patients: A randomized clinical trial. Adv Biomed Res 2014; 3:248. [PMID: 25590026 PMCID: PMC4283243 DOI: 10.4103/2277-9175.146372] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2012] [Accepted: 05/14/2013] [Indexed: 02/06/2023] Open
Abstract
Background: The prevalence of peptic ulcer disease in hemodialysis dependent patients is higher than the general population. These patients are also more prone to upper gastrointestinal bleeding. The aim of this study was to compare the effects of a standard triple therapy with a sequential therapy on Helicobacter pylori eradication in azotemic and hemodialysis patients. Materials and Methods: Forty nine hemodialysis and azotemic patients, naïve to H. pylori treatment, were randomized into two groups to receive either standard triple therapy (pantoprazole 40 mg, amoxicillin 500 mg and clarithromycin 250 mg twice a day for 14 days) or a sequential therapy (pantoprazole 40 mg for 10 days, amoxicillin 500 mg twice a day for the first 5 days and clarithromycin 250 mg + tinidazole 500 mg twice a day just during the second 5 days). H. pylori eradication was evaluated by fecal H. pylori antigen assessment 8 weeks after the treatment. Results: Of 49 patients, 45 patients (21 in triple therapy group and 24 in the sequential group) completed the study. Based on intention to treat analysis, H. pylori eradication rates were 66.7% (95% confidence interval [CI]: 47.8-85.5%) in standard triple therapy group and 84% (95% CI: 69.6-98.3%) in sequential therapy group (P = 0.34). Per-protocol (PP) eradication rates were (95% CI: 76.2%. 6-89.3%) 54 and 87.5% (95% CI: 68.8-95.5%), respectively (P = 0.32). Conclusion: According to Maastricht III consensus report, the results of our study showed that sequential therapy might be a better choice compared with the standard triple therapy in azotemic and hemodialysis patients Iran. We propose to assess the effects of shorter-duration sequential therapy (less than 10 days) for H. pylori eradication.
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Affiliation(s)
- Atieh Makhlough
- Department of Nephrology, Imam Khomeini Hospital, Biology Molecular and Cellular Research Center, Sari, Iran ; Department of Immunology, Biology Molecular and Cellular Research Center, Sari, Iran
| | - Hafez Fakheri
- Department of Gastroenterology, Mazandaran University of Medical Sciences, Sari, Iran
| | | | - Omid Seddighi
- Department of Nephrology, Imam Khomeini Hospital, Sari, Iran
| | | | - Mohammad Khademloo
- Department of Community Medicine, Mazandaran University of Medical Sciences, Sari, Iran
| | - Zohreh Bari
- Department of Internal Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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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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Thomas R, Panackal C, John M, Joshi H, Mathai S, Kattickaran J, Iqbal M. Gastrointestinal complications in patients with chronic kidney disease--a 5-year retrospective study from a tertiary referral center. Ren Fail 2012; 35:49-55. [PMID: 23078600 DOI: 10.3109/0886022x.2012.731998] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Gastrointestinal complications are frequent in patients with renal disease and are responsible for substantial morbidity and mortality among these patients in developing countries. Many times, these patients are subjected to endoscopic evaluation and mucosal biopsies are taken for definitive diagnosis. This study explores the various upper and lower nonneoplastic gastrointestinal complications in patients with chronic kidney disease (CKD) and the role of endoscopic mucosal biopsies in the management of these patients. METHODS Sixty-three patients with CKD, who were referred to endoscopic evaluation and biopsy due to significant gastrointestinal symptoms between January 2007 and December 2011 form the study group. Patients were divided into two groups: group 1 and group 2. Group 1 consisted of patients with CKD stages 1-5 and group 2 consisted of renal allograft recipients. All biopsies were reviewed by an experienced pathologist. Clinical data were collected from patient's medical records. RESULTS There were 38 patients in group 1 and 25 patients in group 2. Twenty-nine out of 38 patients in group 1 presented with upper gastrointestinal (GI) symptoms and underwent esophagogastroduodenoscopy (OGD) evaluation, which showed erosive gastritis as the most common biopsy finding followed by ulcerative esophagitis and duodenitis. These patients were also found to be susceptible to develop ischemic colitis due to hypotensive episodes during dialysis, which are likely to occur during the initial stages of dialysis. The most frequent symptom in group 2 was chronic diarrhea (13 out of 25 patients) for which a colonoscopic examination was done which revealed various infection and drug-related colitis, mycophenolate mofetil (MMF) being a major culprit. CONCLUSION CKD patients with high urea level are prone to develop upper GI symptoms and mostly show erosive gastritis, ulcerative esophagitis, and duodenitis on biopsy. On the contrary, renal allograft recipients mostly develop opportunistic infections and drug-related toxicity in the colon. MMF-related GI toxicity is an underrecognized entity and further prospective studies are required for its better understanding.
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Affiliation(s)
- Renu Thomas
- Department of Pathology, Medical Trust Hospital, Kochi, Kerala, India.
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Jalalzadeh M, Nazarian M, Vafaeimanesh J, Mirzamohammadi F. Comparison of azithromycin and clarithromycin triple therapy regimens for helicobacter pylori eradication in hemodialysis patients. Nephrourol Mon 2012; 4:571-7. [PMID: 23573488 PMCID: PMC3614284 DOI: 10.5812/numonthly.2794] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 11/17/2011] [Accepted: 11/27/2011] [Indexed: 02/06/2023] Open
Abstract
Background Helicobacter pylori eradication with clarithromycin is more expensive than with azithromycin. Objectives This study aimed to compare the effectiveness of these two antibiotics in eradicating H. pylori in hemodialysis (HD) patients. Patients and Methods This is a prospective, randomized, double-blinded clinical trial analysis of HD patients. Patients who had dyspepsia and showed positive results for two of three tests, anti-H. pylori serology, H. pylori stool antigen (HpSAg), or Urease Breath Test (UBT), were included in the study. The subjects consisted of 39 dialysis patients who were randomly divided into two groups that received medication twice daily. Group OAC received 20 mg omeprazol, 500 mg amoxycilin, and 250 mg clarithromycin, and Group OAAz received 20 mg omeprazol, 500 mg amoxicillin, and 250 mg azithromycin. Both regimens were administered for 14 days. Eradication was investigated by performing the UBT and the HpSAg test eight weeks later. Results This study began with 39 patients, 37 of which completed the treatment schedule (20 males and 17 females, mean age 59 years). Two patients died due to MI before beginning treatment. In the OAC group, negative results on the UBT and HpSAg tests were found in 82.4% and 88.2% of the participants, respectively. In the OAAz group, these values were 80% and 85%, respectively. The data showed that the difference between the two regimens was not significant (P = 1.0). Conclusions According to the data, no differences in eradication rates were apparent between the azitromycin and the claritromycin regimens. However, lower cost and fewer complaints could be considered as an advantage of the triple therapy with azithromycin.
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Affiliation(s)
- Mojgan Jalalzadeh
- Departments of Nephrology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Morteza Nazarian
- Departments of Gastroetrology, Vali-e-asr Hospital, Zanjan University of Medical Sciences, Zanjan, IR Iran
| | - Jamshid Vafaeimanesh
- Departments of Internal Medicine, Qom University of Medical Sciences, Qom, IR Iran
- Corresponding author: Jamshid Vafaeimanesh, Departments of Internal Medicine, Qom University of Medical Sciences, Qom, IR Iran. Tel.: +989122248306, Fax: +9824122782476, E-mail:
| | - Fatemeh Mirzamohammadi
- Student Research Committee, Vali-e-asr Hospital, Zanjan University of Medical Sciences, Zanjan, IR Iran
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Goodyear A, Bielefeldt-Ohmann H, Schweizer H, Dow S. Persistent gastric colonization with Burkholderia pseudomallei and dissemination from the gastrointestinal tract following mucosal inoculation of mice. PLoS One 2012; 7:e37324. [PMID: 22624016 PMCID: PMC3356274 DOI: 10.1371/journal.pone.0037324] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Accepted: 04/18/2012] [Indexed: 12/26/2022] Open
Abstract
Melioidosis is a disease of humans caused by opportunistic infection with the soil and water bacterium Burkholderia pseudomallei. Melioidosis can manifest as an acute, overwhelming infection or as a chronic, recurrent infection. At present, it is not clear where B. pseudomallei resides in the mammalian host during the chronic, recurrent phase of infection. To address this question, we developed a mouse low-dose mucosal challenge model of chronic B. pseudomallei infection and investigated sites of bacterial persistence over 60 days. Sensitive culture techniques and selective media were used to quantitate bacterial burden in major organs, including the gastrointestinal (GI) tract. We found that the GI tract was the primary site of bacterial persistence during the chronic infection phase, and was the only site from which the organism could be consistently cultured during a 60-day infection period. The organism could be repeatedly recovered from all levels of the GI tract, and chronic infection was accompanied by sustained low-level fecal shedding. The stomach was identified as the primary site of GI colonization as determined by fluorescent in situ hybridization. Organisms in the stomach were associated with the gastric mucosal surface, and the propensity to colonize the gastric mucosa was observed with 4 different B. pseudomallei isolates. In contrast, B. pseudomallei organisms were present at low numbers within luminal contents in the small and large intestine and cecum relative to the stomach. Notably, inflammatory lesions were not detected in any GI tissue examined in chronically-infected mice. Only low-dose oral or intranasal inoculation led to GI colonization and development of chronic infection of the spleen and liver. Thus, we concluded that in a mouse model of melioidosis B. pseudomallei preferentially colonizes the stomach following oral inoculation, and that the chronically colonized GI tract likely serves as a reservoir for dissemination of infection to extra-intestinal sites.
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Affiliation(s)
- Andrew Goodyear
- Department of Microbiology, Immunology, and Pathology, Rocky Mountain Regional Center for Excellence for Biodefense and Emerging Infectious Diseases Research, Colorado State University, Fort Collins, Colorado, United States of America
| | | | - Herbert Schweizer
- Department of Microbiology, Immunology, and Pathology, Rocky Mountain Regional Center for Excellence for Biodefense and Emerging Infectious Diseases Research, Colorado State University, Fort Collins, Colorado, United States of America
| | - Steven Dow
- Department of Microbiology, Immunology, and Pathology, Rocky Mountain Regional Center for Excellence for Biodefense and Emerging Infectious Diseases Research, Colorado State University, Fort Collins, Colorado, United States of America
- * E-mail:
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Khedmat H, Karami A, Safiri Z, Amini M, Bakhtiari A, Karbasi A, Jayhounian M, Jalalian H, Taheri S. Helicobacter pylori genotypes can predict gastric tissue histopathology: a longitudinal study of Iranian patients. J Infect Public Health 2012; 5:153-8. [PMID: 22541262 DOI: 10.1016/j.jiph.2011.10.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Revised: 08/22/2011] [Accepted: 10/10/2011] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION Several factors have been suggested to account for differences in the virulence of Helicobacter pylori infections in various populations. Evidence suggests the existence of different strains of H. pylori with different degrees of virulence. The present study aimed to investigate the gastric histopathology in Iranian patients infected with H. pylori and to investigate the relationship between the severity of gastritis and four different bacterial virulence-associated genotypes. METHODS AND MATERIALS All of the patients with positive results from a pathological examination, a rapid urease test, and PCR analysis for H. pylori infection were consecutively included into the study. The classification and grading of gastritis were performed according to the Sydney System. Esophagitis was classified endoscopically according to the Savary-Miller grading system. The primers used in this study targeted 16S rRNa (521 bp), Urease A (411 bp), Cag A (400 bp), and 26 kDa (303 bp). RESULTS Twenty-eight patients were included in the study. The presence of Cag A showed a significant relationship with higher gastritis grades (3.0±0.7 vs. 2.3±0.9, p=0.024) and higher scores for H. pylori infection (3.0±0.7 vs. 2.3±0.7, p=0.027). The patients infected with 26 kDa-positive H. pylori had significantly higher infection scores (3.5±0.6 vs. 2.5±0.6, p=0.020). CONCLUSION This study showed that CagA-positive H. pylori infection is associated with more severe gastritis and with increased bacterial density and inflammation in the biopsy specimens. The 303-bp positive genotype was also significantly associated with higher grades of esophagitis. Additional in-depth trials will be helpful in extending our findings.
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Affiliation(s)
- Hossein Khedmat
- Baqiyatallah Research Center for Gastroenterology & Liver Diseases, Tehran, Iran.
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Yang JY, Lee TC, Montez-Rath ME, Paik J, Chertow GM, Desai M, Winkelmayer WC. Trends in acute nonvariceal upper gastrointestinal bleeding in dialysis patients. J Am Soc Nephrol 2012; 23:495-506. [PMID: 22266666 DOI: 10.1681/asn.2011070658] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Impaired kidney function is a risk factor for upper gastrointestinal (GI) bleeding, an event associated with poor outcomes. The burden of upper GI bleeding and its effect on patients with ESRD are not well described. Using data from the US Renal Data System, we quantified the rates of occurrence of and associated 30-day mortality from acute, nonvariceal upper GI bleeding in patients undergoing dialysis; we used medical claims and previously validated algorithms where available. Overall, 948,345 patients contributed 2,296,323 patient-years for study. The occurrence rates for upper GI bleeding were 57 and 328 episodes per 1000 person-years according to stringent and lenient definitions of acute, nonvariceal upper GI bleeding, respectively. Unadjusted occurrence rates remained flat (stringent) or increased (lenient) from 1997 to 2008; after adjustment for sociodemographic characteristics and comorbid conditions, however, we found a significant decline for both definitions (linear approximation, 2.7% and 1.5% per year, respectively; P<0.001). In more recent years, patients had higher hematocrit levels before upper GI bleeding episodes and were more likely to receive blood transfusions during an episode. Overall 30-day mortality was 11.8%, which declined significantly over time (relative declines of 2.3% or 2.8% per year for the stringent and lenient definitions, respectively). In summary, despite declining trends worldwide, crude rates of acute, nonvariceal upper GI bleeding among patients undergoing dialysis have not decreased in the past 10 years. Although 30-day mortality related to upper GI bleeding declined, perhaps reflecting improvements in medical care, the burden on the ESRD population remains substantial.
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Affiliation(s)
- Ju-Yeh Yang
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA 94304, USA
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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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Hwang HS, Song YM, Kim EO, Koh ES, Yoon HE, Chung SJ, Lee SJ, Chang YK, Yang CW, Chang YS, Kim SY. Decisive indicator for gastrointestinal workup in anemic patients with nondialysis chronic kidney disease. Int J Med Sci 2012; 9:634-41. [PMID: 23055815 PMCID: PMC3465847 DOI: 10.7150/ijms.4969] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2012] [Accepted: 09/07/2012] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Anemia and iron deficiency are universal problems in patients with chronic kidney disease (CKD). However, decisive indicator to guide the further gastrointestinal (GI) workup has not been determined. METHODS We included 104 anemic patients with nondialysis-dependent CKD stages 3-5 (38 patients at stage 3, 26 patients at stage 4, and 40 patients at stage 5). Hemoglobin, serum ferritin, transferrin saturation (TSAT), mean corpuscular volume (MCV), and corrected reticulocyte count data were assessed to evaluate diagnostic utility for bleeding-related GI lesions, which were identified by esophagogastroduodenoscopy and colonoscopy. RESULTS Bleeding-related GI lesions were found in 55 (52.9%) patients, and patients with stage 5 CKD had a higher prevalence of gastric lesions than patients with CKD stage 3 or 4 (all p < 0.05). The areas under the receiver operating characteristic curves used to predict bleeding-related lesions were 0.69 for TSAT (p = 0.002) and 0.61 for serum ferritin (p = 0.085). The sensitivity and specificity of a cutoff value for TSAT < 20% were 0.59 and 0.74, respectively. Hemoglobin, MCV, and corrected reticulocyte levels had no significant diagnostic utility. On multivariable logistic regression, the chance of GI lesions increased by 6% for each 1% reduction in TSAT and increased 4.1-fold for patients with CKD stage 5 (all p < 0.05). CONCLUSIONS TSAT is a useful indicator for determining the GI workup in anemic patients with nondialysis-dependent CKD stages 3-5. Stage 5 CKD is independently associated with bleeding-related lesions and TSAT should be used cautiously in these patients.
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Affiliation(s)
- Hyeon Seok Hwang
- Division of Nephrology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Khameneh Z, Sepehrvand N, Hatami S, Afshari A. The Seroprevalence of Helicobacter pylori Infection in Renal Transplant Recipients. Transplant Proc 2011; 43:3720-2. [DOI: 10.1016/j.transproceed.2011.08.112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 06/17/2011] [Accepted: 08/29/2011] [Indexed: 11/25/2022]
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Luo JC, Leu HB, Huang KW, Huang CC, Hou MC, Lin HC, Lee FY, Lee SD. Incidence of bleeding from gastroduodenal ulcers in patients with end-stage renal disease receiving hemodialysis. CMAJ 2011. [PMID: 22083684 DOI: 10.1503/cmaj] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Few large population-based studies have compared the incidence of bleeding of gastroduodenal ulcers between patients with and without end-stage renal disease. We investigated the association between ulcer bleeding and end-stage renal disease in patients receiving hemodialysis, and we sought to identify risk factors for ulcer bleeding. METHODS We performed a nationwide seven-year population study using data from the National Health Insurance Research Database in Taiwan. We identified 36 474 patients with end-stage renal disease who were receiving hemodialysis, 6320 patients with chronic kidney disease and 36 034 controls matched for age, sex and medication use. We performed log-rank testing to analyze differences in survival time without ulcer bleeding among the three groups. We performed Cox proportional hazard regressions to evaluate the risk factors for ulcer bleeding among the three groups and to identify risk factors in patients receiving hemodialysis. RESULTS Patients receiving hemodialysis and those with chronic kidney disease had a significantly higher incidence of ulcer bleeding than controls had (p<0.001). Hemodialysis (hazard ratio [HR] 5.24, 95% confidence interval [CI] 4.67-5.86) and chronic kidney disease (HR 1.95, 95% CI 1.62-2.35) were independently associated with an increased risk of ulcer bleeding. Diabetes mellitus, coronary artery disease, cirrhosis and use of nonsteroidal anti-inflammatory drugs were risk factors for ulcer bleeding in patients with end-stage renal disease who were receiving hemodialysis INTERPRETATION Patients with end-stage renal disease who are receiving hemodialysis had a high risk of ulcer bleeding. Diabetes mellitus, coronary artery disease, cirrhosis and the use of nonsteroidal anti-inflammatory drugs were important risk factors for ulcer bleeding in these patients.
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Affiliation(s)
- Jiing-Chyuan Luo
- Department of Medicine, National Yang-Ming University, School of Medicine, and Taipei Veterans General Hospital, Taipei, Taiwan.
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Luo JC, Leu HB, Huang KW, Huang CC, Hou MC, Lin HC, Lee FY, Lee SD. Incidence of bleeding from gastroduodenal ulcers in patients with end-stage renal disease receiving hemodialysis. CMAJ 2011; 183:E1345-51. [PMID: 22083684 DOI: 10.1503/cmaj.110299] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Few large population-based studies have compared the incidence of bleeding of gastroduodenal ulcers between patients with and without end-stage renal disease. We investigated the association between ulcer bleeding and end-stage renal disease in patients receiving hemodialysis, and we sought to identify risk factors for ulcer bleeding. METHODS We performed a nationwide seven-year population study using data from the National Health Insurance Research Database in Taiwan. We identified 36 474 patients with end-stage renal disease who were receiving hemodialysis, 6320 patients with chronic kidney disease and 36 034 controls matched for age, sex and medication use. We performed log-rank testing to analyze differences in survival time without ulcer bleeding among the three groups. We performed Cox proportional hazard regressions to evaluate the risk factors for ulcer bleeding among the three groups and to identify risk factors in patients receiving hemodialysis. RESULTS Patients receiving hemodialysis and those with chronic kidney disease had a significantly higher incidence of ulcer bleeding than controls had (p<0.001). Hemodialysis (hazard ratio [HR] 5.24, 95% confidence interval [CI] 4.67-5.86) and chronic kidney disease (HR 1.95, 95% CI 1.62-2.35) were independently associated with an increased risk of ulcer bleeding. Diabetes mellitus, coronary artery disease, cirrhosis and use of nonsteroidal anti-inflammatory drugs were risk factors for ulcer bleeding in patients with end-stage renal disease who were receiving hemodialysis INTERPRETATION Patients with end-stage renal disease who are receiving hemodialysis had a high risk of ulcer bleeding. Diabetes mellitus, coronary artery disease, cirrhosis and the use of nonsteroidal anti-inflammatory drugs were important risk factors for ulcer bleeding in these patients.
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Affiliation(s)
- Jiing-Chyuan Luo
- Department of Medicine, National Yang-Ming University, School of Medicine, and Taipei Veterans General Hospital, Taipei, Taiwan.
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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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Shirazian S, Radhakrishnan J. Gastrointestinal disorders and renal failure: exploring the connection. Nat Rev Nephrol 2010; 6:480-92. [PMID: 20606629 DOI: 10.1038/nrneph.2010.84] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Gastrointestinal complications are known to commonly occur in patients with renal failure. Uremia and dialysis have long been speculated to increase the risk of lesions in the gastrointestinal tract and accessory organs. In addition, gastrointestinal procedures such as gastrointestinal bypass surgery and the administration of colonoscopy preparations can lead to the development of renal complications. Results from studies that have attempted to define the association between renal dysfunction and gastrointestinal complications are, however, conflicting and limited by small and varied sample populations. No clear management guidelines currently exist for many of the gastrointestinal problems that accompany renal failure. This Review examines the existing data on gastrointestinal complications in patients with chronic kidney disease and end-stage renal disease and aims to outline the etiology and management of common gastrointestinal disorders in such patients.
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Affiliation(s)
- Shayan Shirazian
- Division of Nephrology, Columbia University Medical Center, 622 W 168th Street, PH4-124, New York, NY 10032, USA
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Telkes G, Peter A, Tulassay Z, Asderakis A. High frequency of ulcers, not associated with Helicobacter pylori, in the stomach in the first year after kidney transplantation. Nephrol Dial Transplant 2010; 26:727-32. [PMID: 20603242 DOI: 10.1093/ndt/gfq401] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Although gastrointestinal (GI) symptoms are very frequent in organ transplant patients, there is a paucity of data about the endoscopic findings of kidney recipients. METHODS Two thousand one hundred and thirty-five kidney transplants were performed between 1994 and 2007. During that period, 672 gastroscopies were performed in 543 of those patients. Their mean age was 49.5 years and 56.9% were male. Immunosuppressive combinations included cyclosporine-mycophenolate-steroids, cyclosporine-steroids and tacrolimus-mycophenolate mofetil-steroids. Ninety-eight percent of the patients received acid suppression therapy. RESULTS The rate of clinically significant endoscopic findings was 84%. Macroscopic findings included inflammation in 46.7%, oesophagitis in 24.7%, ulcer in 16.9% and erosions in 14.8% of cases. Twenty-nine percent of endoscopies showed ulcer disease more frequently in the first 3 months (P=0.0014) after transplantation than later, and 45.7% of all ulcers developed in the first year. The presence of Helicobacter pylori was verified in 20.9% of cases, less than in the general, and also in the uraemic population (P<0.0001). There was no association between the presence of H. pylori and ulcers (P=0.28). Steroid pulse treatment for rejection was not associated with more ulcers (P=0.11); the use of mycophenolate mofetil increased the risk of erosions by 1.8-fold. CONCLUSION More than 25% of all kidney recipients required upper endoscopy in their 'post-transplant life'; the prevalence of 'positive findings' and ulcer disease was higher than in the general population (P<0.0001). The most vulnerable period is the first 3 months. Mycophenolate mofetil had an impact on GI complications, whilst the presence of H. pylori in the transplant population is not associated with the presence of ulcers.
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Affiliation(s)
- Gabor Telkes
- Transplantation and Surgical Clinic, Research Group of Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary.
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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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Mortazavi F, Rafeey M. Endoscopic findings and Helicobacter pylori in children on long-term hemodialysis. Pak J Biol Sci 2008; 11:1840-3. [PMID: 18817227 DOI: 10.3923/pjbs.2008.1840.1843] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study is to evaluate the prevalence of GI symptoms, endoscopic abnormalities, histologic gastritis and Helicobacter pylori infection in children with End Stage Renal Disease (ESRD) undergoing maintenance hemodialysis. Upper endoscopy and gastric biopsy were performed in 31 consecutive ESRD children from 2002-2007, before renal transplantation. H. pylori status was determined by urease test and histology. The mean age of patients was 11 +/- 3.3 years (4-16 year). The mean duration of dialysis was 12.4 +/- 11 months (1.5-54 months). Seventeen patients (54.8%) were symptomatic. Twenty patients (64.5%) had endoscopic abnormalities. Antral erythema, esophagitis, antral nodularity and diffuse gastritis were common endoscopic findings. Endoscopic abnormalities were more common in symptomatic patients than asymptomatic patients (p < 0.05). Twenty patients (64.5%) were H. pylori positive. There was no statistical correlation between age, sex, serum creatinine level, presence of any symptoms and endoscopic abnormalities with H. pylori positivity. The mean duration of dialysis in H. pylori negative patients was significantly longer in comparison with H. pylori positive patients. High prevalence of eodoscopic abnormalities and H. pylori infection in both symptomatic and asymptomatic patients emphasize the necessity of upper GI evaluation in ESRD children before renal transplantation.
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Affiliation(s)
- Fakhrossadat Mortazavi
- Department of Pediatric Nephrology, Faculty of Medicine, Liver and Gastroenterology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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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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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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