Dyspepsia Amongst End Stage Renal Disease Undergoing Hemodialysis: Views from a Large Tertiary Care Center. J Transl Int Med. 2018;6:78-81. [PMID: 29984202 PMCID: PMC6032184 DOI: 10.2478/jtim-2018-0013]

The prevalence of functional dyspepsia using Rome IV questionnaire among chronic kidney disease patients

Background: Symptoms of dyspepsia are usually encountered by chronic kidney disease patients. Abdominal discomfort is commonly seen in CKD patients with no other causes of organic affection. Aim: to determine the prevalence of functional dyspepsia in CKD patients, and which subtype is predominant in them. Materials and patients: This observational study included 150 CKD patients. Clinical and laboratory data were recorded for every patient. All the patients were interviewed using the ROME IV questionnaire of functional dyspepsia. Patients fulfilling criteria for functional dyspepsia were exposed to upper GI endoscopy. Results: Overall, 73 (48.7%) of CKD patients were males and 77 (51.3%) were females with mean age of (45.71 ± 9.59) and mean BMI (26.58 ± 5.39). The frequency of functional dyspepsia among CKD patients was determined to be 14.7% (22 out of 150 patients). Among those affected by functional dyspepsia, the most prevalent subtype was found to be Epigastric Pain Syndrome (EPS), accounting for 59% (13 out of 22 cases). The most common predictor of FD in CKD patients was chronic HCV infection, hemodialysis, stage of CKD and eGFR as revealed by Univariate regression analysis. Conclusion: The prevalence of FD amongst CKD patients is 14.7% with EPS the predominant subtype. Male patients, HCV patients, patients with higher CKD stages and highly impaired eGFR (low eGFR) are more probable to have FD.

Pathological diagnosis and immunohistochemical analysis of giant retrosternal goiter in the elderly: A case report

BACKGROUND

Elderly giant retrosternal thyroid goiter is a rare yet significant medical condition, often presenting clinical symptoms that can be confused with other diseases, posing diagnostic and therapeutic challenges. This study aims to delve into the characteristics and potential mechanisms of this ailment through pathological diagnosis and immunohistochemical analysis, providing clinicians with more precise diagnostic and treatment strategies.

CASE SUMMARY

A 77-year-old male, was admitted to hospital with the chief complaint of finding a goiter in the semilunar month during physical examination, accompanied by dyspnea. Locally protruding into the superior mediastinum, the adjacent structure was compressed, the trachea was compressed to the right, and the local lumen was slightly narrowed. The patient was diagnosed with giant retrosternal goiter. Considering dyspnea caused by trachea compression, our department planned to perform giant retrosternal thyroidectomy. Immunohistochemical results: Tg (+), TTF-1 (+), Calcitonin (CT) (I), Ki-67 (+, about 20%), CD34 (-). Retrosternal goiter means that more than 50% of the volume of the thyroid gland is below the upper margin of the sternum. As retrosternal goiter disease is a relatively rare disease, once the disease is diagnosed, it should be timely surgical treatment, and the treatment is more difficult, the need for professional medical team for comprehensive treatment.

CONCLUSION

The imaging manifestations of giant retrosternal goiter are atypical, histomorphology and immunohistochemistry can assist in its diagnosis. This article reviews the relevant literature of giant retrosternal goiter immunohistochemistry and shows that giant retrosternal goiter is positive for Tg, TTF-1, and Ki-67.

Dyspepsia in Montenegrin chronic kidney disease patients undergoing hemodialysis: endoscopic and histopathological features

PURPOSE

The main purpose of this study was to analyze the characteristics of dyspepsia and contributing factors in Montenegrin maintenance hemodialysis patients.

METHODS

The study included 43 patients undergoing hemodialysis with symptoms of dyspepsia and 40 control dyspeptic subjects with preserved kidney function. All subjects underwent an interview about dyspeptic symptoms, physical and biochemical examination, and upper gastrointestinal endoscopy with pathohistological analysis of biopsy specimens.

RESULTS

Early satiety, bloating and heartburn were the most common symptoms in hemodialysis patients but without significant difference in frequency in relation to controls. Chronic kidney disease patients had statistically lower concentration of total proteins and albumin (p < 0.001), as well lower BMI values (p = 0.002). Despite this, no significant correlation of laboratory parameters with dyspeptic symptoms was found. Pathohistological examination indicated that the most common finding in hemodialysis patients was chronic active gastritis (58%), while chronic atrophic gastritis was significantly more common in dialytic patients (p = 0.032). Patients on hemodialysis had more frequently atrophy of corpus mucosa, which was positively related to dialysis duration (p = 0.001) and negatively related to pH values (p = 0.004) and bicarbonate concentration (p = 0.049). Helicobacter pylori was considerably more common in patients who underwent shorter time on hemodialysis (p < 0.001) and had higher values of bicarbonate (p = 0.037).

CONCLUSION

Maintenance hemodialysis patients are at risk for chronic gastric diseases that correlated with both dialysis vintage and duration.

Endoscopic full-thickness resection for treating small tumors originating from the muscularis propria in the gastric fundus: An improvement in technique over 15 years

BACKGROUND

The fundus of the stomach is regarded as a difficult area for endoscopic resection of small tumors originating from the muscularis propria (MP tumors). Three endoscopic resection techniques have been developed to treat these tumors, including ligation-assisted endoscopic full-thickness resection (L-EFTR), snare-assisted EFTR (S-EFTR), and endoscopic submucosal dissection-assisted EFTR (E-EFTR). To date, no studies have compared these techniques.

AIM

We aimed to evaluate and compare S-EFTR with L-EFTR and E-EFTR for treating small MP tumors in the gastric fundus.

METHODS

We retrospectively reviewed patients with primary small MP tumors in the gastric fundus and treated by these three techniques between January 2016 and December 2018 at Shengjing Hospital, China. Standard demographic and clinicopathologic data, including sex, age, tumor size, surgeon details, and pathological results, were collected. Data regarding operation duration, cost, en-bloc resection, and severe complications were also extracted and compared.

RESULTS

A total of 36 patients (27 women) with a mean age of 55.8 ± 10.20 years were included in this study. The mean tumor size was 9.0 ± 3.98 mm. All the methods showed a 100% en-bloc resection rate and 0% severe complication rate. There was no statistically significant difference among the three groups in the operation duration (P = 0.148). The cost comparison for the whole procedure was as follows: E-EFTR > L-EFTR > S-EFTR (5837.5 ± 7212.96 CNY, 5970.7 ± 3465.27 CNY, 5852.0 ± 6438.25 CNY, respectively, P < 0.001).

CONCLUSION

S-EFTR, L-EFT, and E-EFTR are all effective for resection of small MP tumors in the gastric fundus. S-EFTR is superior in terms of cost-effectiveness.