Wadhwa Rajesh Kumar, Nazeer Aisha, Rai Ayesha Aslam, Luck Nasir Hassan
From the Department of Hepato-Gastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
Exp Clin Transplant. 2018 Oct;16(5):522-527. doi: 10.6002/ect.2017.0132. Epub 2018 Mar 9.
We investigated the incidence of gastrointestinal disorders requiring endoscopic and histopathologic diagnoses in renal transplant recipients.
In this retrospective analysis, we examined records of patients seen at the Department of Hepato-Gastroenterology and Transplantation Sciences, Sindh Institute of Urology and Trans?lantation (Karachi, Pakistan) from January 2010 to December 2014. Renal transplant recipients with gastrointestinal disorders who required endoscopy, including proctoscopy and upper and lower gastrointestinal endoscopy as per indication, were included.
Of 1770 patients included in this study, most were male patients (n = 1517; 85.7%). In this patient group, 1957 endoscopies, including proctoscopies, were performed, which included 1033 esophagogastroduodenoscopies (52.8%), 571 sigmoidoscopies (29.2%), and 107 colonoscopies (5.5%). The most common indications were diarrhea (n = 697; 31.2%) and weight loss (n = 690; 31%). Findings showed esophageal candidiasis in 127 patients (12%); however, biopsy revealed Candida species in 33 patients (34%). Cytomegalovirus and herpes esophagitis were observed in 8 (8.3%) and 5 patients (5.2%). Helicobacter pylori gastritis was seen in 119 patients (15.4%), cytomegalovirus gastritis in 9 patients (1.2%), and gastric lymphoma in 1 patient (0.1%). Duodenal fissuring was the most common pathology observed during endoscopy (396 patients; 33.9%), followed by decreased height of duodenal folds in 157 patients (13.4%), with biopsy showing sprue in 325 patients (37.6%) and giardiasis in 118 patients (13.7%). Lower gastrointestinal endoscopy showed ulcers in 198 patients (24.6%) and polyps in 31 patients (3.9%). Histopathologic examination showed cytomegalovirus colitis in 89 patients (15.5%), amebic colitis in 21 (3.7%), and tuberculosis in 11 (1.9%).
We observed a wide spectrum of pathologic lesions, including opportunistic infections, in endoscopic biopsies from our renal transplant patients. Cytomegalovirus colitis was the most common infection in the lower gastrointestinal tract, whereas giardiasis was the most common in the duodenum.
我们调查了肾移植受者中需要内镜和组织病理学诊断的胃肠道疾病的发病率。
在这项回顾性分析中，我们检查了2010年1月至2014年12月在巴基斯坦卡拉奇信德泌尿与移植研究所肝脏胃肠病学与移植科学部就诊患者的记录。纳入有胃肠道疾病且需要内镜检查的肾移植受者，包括根据指征进行的直肠镜检查以及上、下消化道内镜检查。
本研究纳入的1770例患者中，大多数为男性患者（n = 1517；85.7%）。在该患者组中，共进行了1957次内镜检查，包括直肠镜检查，其中食管胃十二指肠镜检查1033次（52.8%），乙状结肠镜检查571次（29.2%），结肠镜检查107次（5.5%）。最常见的指征是腹泻（n = 697；31.2%）和体重减轻（n = 690；31%）。检查发现127例患者（12%）有食管念珠菌病；然而，活检显示33例患者（34%）有念珠菌属感染。观察到8例（8.3%）患者有巨细胞病毒食管炎，5例（5.2%）有疱疹性食管炎。119例患者（15.4%）有幽门螺杆菌胃炎，9例患者（1.2%）有巨细胞病毒胃炎，1例患者（0.1%）有胃淋巴瘤。十二指肠裂是内镜检查中最常见的病理情况（396例患者；33.9%），其次是157例患者（13.4%）十二指肠皱襞高度降低，活检显示325例患者（37.6%）有口炎性腹泻，118例患者（13.7%）有贾第虫病。下消化道内镜检查显示198例患者（24.6%）有溃疡，31例患者（3.9%）有息肉。组织病理学检查显示89例患者（15.5%）有巨细胞病毒结肠炎，21例患者（3.7%）有阿米巴结肠炎，11例患者（1.9%）有结核病。
我们在肾移植患者的内镜活检中观察到了广泛的病理病变，包括机会性感染。巨细胞病毒结肠炎是下消化道最常见的感染，而贾第虫病在十二指肠中最为常见。
