Bunchorntavakul Chalermrat, Atsawarungruangkit Ampom
J Med Assoc Thai. 2014 Nov;97 Suppl 11:S62-8.
Upper gastrointestinal (UGI) diseases are more common in patients with end-stage renal disease (ESRD) compared to general populations. Previous studies demonstrated that ESRD patients with UGI disease are at increased risk for developing complications following kidney transplantation (KT). Prevalence of UGI lesions and Helicobacter pylori in asymptomatic KT candidates remain unclear
To evaluate the prevalence of UGI lesions and Helicobacter pylori in nondyspeptic KT candidates.
The authors retrospectively and prospectively enrolled consecutive patients with ESRD who underwent esophagogastroduodenoscopy (EGD) as part of pre-KT evaluation at a single tertiary center (Rajavithi Hospital, Bangkok) between 2008 and 2013. Patients with significant dyspeptic symptoms, known UGI disease and received PPI/NSAIDs/antibiotics within two weeks before EGD were excluded. EGD was performed with random biopsies for rapid urease test and histology.
In all, 107 ESRD patients were included; 53.0% were men and a median age was 38.7 (15.9-65.0) years. A total of 95% of patients had been on hemodialysis with the median duration of 2.1 (0.2-15.3) years. Significant EGD findings (defined as lesions other than normal and nonerosive gastritis) were encountered in 46% of patients; most lesions were erosive gastroduodenitis and peptic ulcers. Among several baseline demographic and laboratory parameters analyzed, only older age was significantly associated with significant EGD findings (p = 0.026). Helicobacter pylori infection was documented in 27.1% of patients. This prevalence tended to be lower than the prevalence of H. pylori of 39% in 105 sex- and age-matched, nonESRD patients without significant EGD findings who underwent EGD during the same time, but not statistically significant (p = 0.08).
The authors demonstrated a considerable prevalence of acid-related UGI diseases and H. pylori infection in nondyspeptic KT candidates. Therefore, EGD is a reasonable part of routine preKT evaluations, at least in our part of the world, to promptly detect and precisely manage the problem.
与普通人群相比，晚期肾病（ESRD）患者上消化道（UGI）疾病更为常见。先前的研究表明，患有UGI疾病的ESRD患者在肾移植（KT）后发生并发症的风险增加。无症状KT候选者中UGI病变和幽门螺杆菌的患病率仍不清楚。
评估无消化不良症状的KT候选者中UGI病变和幽门螺杆菌的患病率。
作者回顾性和前瞻性地纳入了2008年至2013年期间在单一三级中心（曼谷拉贾维蒂医院）接受食管胃十二指肠镜检查（EGD）作为KT术前评估一部分的连续性ESRD患者。排除有明显消化不良症状、已知UGI疾病以及在EGD前两周内接受过质子泵抑制剂（PPI）/非甾体抗炎药（NSAIDs）/抗生素治疗的患者。进行EGD检查并随机活检以进行快速尿素酶试验和组织学检查。
总共纳入了107例ESRD患者；53.0%为男性，中位年龄为38.7（15.9 - 65.0）岁。95%的患者接受过血液透析，中位透析时间为2.1（0.2 - 15.3）年。46%的患者出现了明显的EGD检查结果（定义为除正常和非糜烂性胃炎以外的病变）；大多数病变为糜烂性胃十二指肠炎症和消化性溃疡。在分析的几个基线人口统计学和实验室参数中，只有年龄较大与明显的EGD检查结果显著相关（p = 0.026）。27.1%的患者记录有幽门螺杆菌感染。这一患病率往往低于同期接受EGD检查的105例年龄和性别匹配、无明显EGD检查结果的非ESRD患者中39%的幽门螺杆菌患病率，但差异无统计学意义（p = 0.08）。
作者证明在无消化不良症状的KT候选者中，与酸相关的UGI疾病和幽门螺杆菌感染患病率相当高。因此，EGD是常规KT术前评估的合理组成部分，至少在我们这个地区，以便及时发现并精确处理该问题。
