Smyrlis A, Kogias D, Chalkidou A, Panagoutsos S, Kantartzi K, Papadopoulos V, Mimidis K
Department of Nephrology, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece.
First Department of Internal Medicine, University Hospital of Alexandroupolis, Democritus University of Thrace, Alexandroupolis, Greece.
Hippokratia. 2024 Jan-Mar;28(1):22-28.
Gastrointestinal (GI) bleeding is common among hemodialysis (HD) patients. Endoscopic examination of the upper and lower GI tract often fails to identify hemorrhagic lesions in anemic HD patients. The study aims to evaluate lesions of the small bowel mucosa in HD vs non-HD patients with suspected small-bowel bleeding (SSBB) using capsule endoscopy (CE) after negative upper and lower GI endoscopies.
This prospective cross-sectional study included all consecutive patients presenting with occult GI bleeding at the Dialysis Unit (HD patients) and the Gastroenterology Outpatient Clinic (non-HD patients) of the University Hospital of Alexandroupolis. Within a pre-specified period of 13 months (01/07/2022 to 31/07/2023), we collected all relevant demographic data, laboratory parameters, comorbidity records, treatment profiles, and endoscopic findings. We used univariate and optimal scaling multivariate analyses to evaluate all parameters correlating with CE findings and Rhemitt score.
The study included 100 patients (25 HD and 75 non-HD). Considering any lesion (oozing blood, red spots, angiodysplasias, and erosive/ulcerative lesions) at any site (duodenum, jejunum, and ileum) as separate binary variables, the prevalence per patient was superior in HD patients (3.8 ± 1.6 vs 1.3 ± 1.4; p <0.001). More specifically, endoscopic capsule findings in HD vs non-HD patients identified oozing blood (28 % vs 15 %; p =0.133), red spots (96 % vs 44 %; p <0.001), angiodysplasias (32 % vs 9 %; p =0.006), and erosive/ulcerative lesions (64 % vs 24 %; p <0.001). In 25 non-HD patients, no findings were observed (p =0.001). The number of total endoscopic findings was independently correlated with dialysis (p <0.001), male sex (p =0.048), dyslipidemia (p =0.004), liver disease (p =0.001), and mean corpuscular volume (MCV) (p =0.015). Lastly, we found that HD patients rebleed more often (Rhemitt score 6.5 ± 1.4 vs 2.9 ± 2.1; p <0.001). The Rhemitt score was independently correlated with dialysis (p <0.001), body mass index (p =0.024), MCV (p <0.001), smoking (p <0.001), dyslipidemia (p =0.007), GI bleeding (p <0.001), Calcium channel blockers (p =0.023), and preparation (p =0.001).
Compared with non-HD patients, HD patients who were investigated for potential GI bleeding demonstrated more severe and frequent small intestinal lesions with a higher probability of rebleeding. HIPPOKRATIA 2024, 28 (1):22-28.
胃肠道出血在血液透析（HD）患者中很常见。上、下消化道内镜检查往往无法识别贫血HD患者的出血性病变。本研究旨在评估上、下消化道内镜检查阴性后，使用胶囊内镜（CE）对疑似小肠出血（SSBB）的HD患者与非HD患者的小肠黏膜病变情况。
这项前瞻性横断面研究纳入了亚历山德鲁波利斯大学医院透析科（HD患者）和胃肠病门诊（非HD患者）所有连续出现隐匿性胃肠道出血的患者。在13个月的预定时间段内（2022年7月1日至2023年7月31日），我们收集了所有相关的人口统计学数据、实验室参数、合并症记录、治疗情况和内镜检查结果。我们使用单变量和最优尺度多变量分析来评估与CE结果和雷米特评分相关的所有参数。
该研究纳入了100例患者（25例HD患者和75例非HD患者）。将任何部位（十二指肠、空肠和回肠）的任何病变（渗血、红点、血管发育异常和糜烂/溃疡性病变）视为独立的二元变量，HD患者中每位患者的患病率更高（3.8±1.6比1.3±1.4；p<0.001）。更具体地说，HD患者与非HD患者的内镜胶囊检查结果显示，渗血（28%比15%；p=0.133）、红点（96%比44%；p<0.001）、血管发育异常（32%比9%；p=0.006）和糜烂/溃疡性病变（64%比24%；p<0.001）。在25例非HD患者中，未观察到任何结果（p=0.001）。内镜检查结果总数与透析（p<0.001）、男性（p=0.048）、血脂异常（p=0.004）、肝病（p=0.001）和平均红细胞体积（MCV）（p=0.015）独立相关。最后，我们发现HD患者再出血更频繁（雷米特评分6.5±1.4比2.9±2.1；p<0.001）。雷米特评分与透析（p<0.001）、体重指数（p=0.024）、MCV（p<0.001）、吸烟（p<0.001）、血脂异常（p=0.007）、胃肠道出血（p<0.001）、钙通道阻滞剂（p=0.023）和准备情况（p=0.001）独立相关。
与非HD患者相比，因潜在胃肠道出血接受检查的HD患者表现出更严重、更频繁的小肠病变，再出血的可能性更高。《希波克拉底》2024年，28(1):22 - 28。
