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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO EDITOR Table of Contents   
Year : 2006  |  Volume : 17  |  Issue : 2  |  Page : 232-233
Should All Dialysis Patients be Screened and Treated for Helicobacter Pylori Preemptively before Renal Transplant?


1 Department of Medicine, Dammam Central Hospital, P.O. Box 12723, Dammam 31483, Saudi Arabia
2 Kanoo Kidney Centre, Dammam Central Hospital, P.O. Box 12723, Dammam 31483, Saudi Arabia

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How to cite this article:
Mukhtar A, Malik TQ, Karkar A. Should All Dialysis Patients be Screened and Treated for Helicobacter Pylori Preemptively before Renal Transplant?. Saudi J Kidney Dis Transpl 2006;17:232-3

How to cite this URL:
Mukhtar A, Malik TQ, Karkar A. Should All Dialysis Patients be Screened and Treated for Helicobacter Pylori Preemptively before Renal Transplant?. Saudi J Kidney Dis Transpl [serial online] 2006 [cited 2019 Jul 21];17:232-3. Available from: http://www.sjkdt.org/text.asp?2006/17/2/232/35798
To The Editor:

Helicobacter pylori (H. pylori)
play an important role in the pathogenesis of active gastritis and peptic ulcer disease. [1] Upper gastrointestinal mucosal lesions are common in patients with end-stage renal disease (ESRD) on dialysis and those with renal transplants.

A 55-year-old Saudi woman who was on chronic dialysis for the past three years and received a live related kidney transplant four months ago, complained of epigastric pain and vomiting. She was on triple immunosuppressive therapy consisting of corticosteroids, cyclo­sporine and mycophenolate mofetil. The prertrnsplant upper gastrointestinal (GI) endoscopy showed mild erythematic non­erosive gastritis in the antrum, and the biopsy showed mild chronic gastritis due to H. pylori infection. She was treated with oral proton pump inhibitor only and remained asympto­matic. The repeat of the upper GI endoscopy revealed severe erosive antral gastritis, erosive duodinitis and anterior wall duodenal ulcer. The biopsy of the antral mucosa revealed severe gastritis due to H. pylori infection and the patient was treated with triple therapy (amoxycillin, clarithromycin and omeprazole) for two weeks to which she responded very well.

Renal transplant recipients have prevalence of up to 80% of H. pylori colonization. [2] Gastro­duodenal lesions in the H. pylori infected dialysis and allograft recipients include atrophic, superficial, and erosive gastritis and gastric ulcer. [3] It has been a controversial issue whether to treat or not treat H. pylori infected, asymptomatic patients with ESRD prior to renal transplantation. Renal transplant patients are at increased risk for developing severe upper gastrointestinal disease, [2] and infected patients experience significantly more frequent upper gastrointestinal symptoms. [4]

In our opinion, all patients awaiting a renal transplant should be preemptively screened for H. pylori infection. They should be treated if found to be infected before kidney transplant­ation is considered, as the chances of developing severe disease in the post transplant period while on immunosuppression are quite high.

 
   References Top

1.Ozgur O, Boyacioglu S, Ozdogan M, Gur G, Telatar H, Haberal M. Helicobactor Pylori infection in haemodialysis patients and renal transplant recipients. Nephrol Dial Transplant 1997;12(2):289-91.  Back to cited text no. 1    
2.Hruby Z, Myszka-Bijak K, gosciniak G, et al. Helicobacter pylori in kidney allograft recipients: high prevalence of colonization and low incidence of active inflammatory lesions. Nephron 1997;75(1):25-9.  Back to cited text no. 2    
3.Tokushima H. Role of Helicobacter pylori in gastro-duodenal mucosal lesions in patients with end stage renal disease under dialysis treatment. Nippon Jinzo gakkai Shi 1995;37(9):503-10.  Back to cited text no. 3    
4.Ala-Kaila K, Vaajalahti P, Karvonen Al, Kokk M. Gastric Helicobacter and upper gastrointestinal symptoms in chronic renal failure. Ann Med 1991;23(4):403-6.  Back to cited text no. 4    

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Correspondence Address:
Attiya Mukhtar
Department of Medicine, Dammam Central Hospital, P.O. Box 12723, Dammam 31483
Saudi Arabia
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PMID: 16903635

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