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Saudi Journal of Kidney Diseases and Transplantation
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ORIGINAL ARTICLE Table of Contents   
Year : 2009  |  Volume : 20  |  Issue : 2  |  Page : 223-226
Prevalence of Helicobacter pylori infection in maintenance hemodialysis patients with non-ulcer dyspepsia


Department of Internal Medicine, Shahrekord University of Medical Sciences, Hajar Medical, Educational and Therapeutic Center, Shahrekord, Iran

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   Abstract 

The purpose of this prospective study is to determine the prevalence of Helico­bacter pylori (H. pylori) infection among stable chronic hemodialysis (HD) patients having non ulcer dyspepsia. The study was carried out on 80 patients consisting of 40 patients with dyspepsia and 40 consecutive control subjects without renal disease and dyspepsic symptoms. Mean age of patients were 56 ± 14 and 47 ± 15 respectively. This study showed no significant difference of H. pylori infection between the two groups. Tissue examination of gastric antrum showed higher localization of H. pylori in HD patients in contrast to controls. This finding has not been reported before and needs further confirmation and evaluation for its significance.

Keywords: Hemodialysis, End-stage renal failure, Helicobacter pylori

How to cite this article:
Asl MH, Nasri H. Prevalence of Helicobacter pylori infection in maintenance hemodialysis patients with non-ulcer dyspepsia. Saudi J Kidney Dis Transpl 2009;20:223-6

How to cite this URL:
Asl MH, Nasri H. Prevalence of Helicobacter pylori infection in maintenance hemodialysis patients with non-ulcer dyspepsia. Saudi J Kidney Dis Transpl [serial online] 2009 [cited 2020 Feb 24];20:223-6. Available from: http://www.sjkdt.org/text.asp?2009/20/2/223/45526

   Introduction Top


Helicobacter pylori (H. pylori) is a spiral­shaped bacterium that causes chronic infection in human stomachs, and often leads to gastritis and peptic ulcers. [1],[2] Helicobacter pylori has been shown to play an important role in the development of gastritis and gastric ulcers. [1] Patients with chronic renal failure often have dyspeptic symptoms and may develop peptic ulcer disease or digestive disorders leading to severe gastrointestinal (GI) complications. [3] Eso­phagogastroduodenoscopy is an important in­vestigation for upper gastrointestinal (UGI) disorders and their management [4] and it was emphasized that endoscopic examination with histopathologic evaluation should be consi­dered in symptomatic patients and in areas where H. pylori is endemic. [5],[6] Studies on the relationship between high serum urea nitrogen, creatinine and H pylori infection in hemodia­lysis patients still give conflicting results. 7 While the precise nature of the gastroduodenal involvement in these patients remains unclear, the link between helicobacter pylori, chronic gastritis and peptic ulcer disease has grown stronger. [8],[9] There are few data concerning the epidemiology of H. pylori in patients on main­tenance hemodialysis (HD) in developing coun­tries specially with non-ulcer dyspepsia. We therefore aimed to investigate the prevalence of H. pylori infection in regular hemodialysis patients with various upper gastrointestinal (UGI) symptoms and agreed forendoscopic assessment of upper GI tract for H pylori infection.


   Patients and Methods Top


This is a cross-sectional study which was con­ducted on patients with end-stage renal disease (ESRD) undergoing maintenance hemodialysis with acetate based dialysate and polysulfone membranes and compared to a group of age­matched patients without renal disease and re­ferred by the physicians for upper GI endos­copy, because of various gastrointestinal signs and symptoms.

Hemodialysis patients were under regular he­modialysis at least for 6 months before the study and control group were patients who had normal renal function which was diagnosed by BUN and creatinine measurement through the study. Exclusion criteria for all participants were; use of proton pomp inhibitors, H2 blo­ckers, antacids and antibiotics for at least four past weeks before the study, cigarette smoking and presence of peptic ulcer diagnosed by endoscopic evaluation. Questions regarding the signs and symptoms of upper GI system were as follows:

  1. nausea or vomiting or abdominal distention
  2. pyrosis
  3. night pain
  4. epigastric pain
  5. the history of melena or hematemesis.


Each mentioned signs and symptoms was given one number and so presence of all five signs and symptoms would result in a maxi­mum score of 5. All study subjects also signed the consent for endoscopic procedure.

For the study first a general physician ga­thered the data and examined all participants. Before the endoscopic procedure for all hemo­dialysis patients, CBC, PT, PTT and BT were assessed and to avoid the probable hemorrha­gic episode during the biopsy two nasal puffs of DDAVP (Arginine Vasopressine) thirty mi­nutes before the endoscopy were used.

Bacteriologic examination included micros­copic examination for detection of Helicobac­ter pylori by giemsa staining.

The procedure was performed using a video endoscope (gastroduodenoscope Pentax FG­29W; Japan). First two pieces from the antrum were obtained, and then from the gastric fun­dus, two specimens from gastric body were obtained and collected in separate bottles. The above mentioned 6 specimens were subjected to histopathologic and bacteriologic assessment for H. pylori.

For statistical analysis, the data are expressed as the Mean ± SD values. Differences were assessed using the Chi-Square test.

For comparison of localization of H. pylori between three parts of the stomach according to the tacked biopsies the Cochran test for each groups were used separately. All statistical analysis was performed using SPSS (version 11.5.00). Statistical significance was determined at a p-value lower than 0.05.


   Results Top


The study was carried out on 80 patients consisting of 40 ESRD patients on mainte­nance HD patients (female= 11, male= 29) and 40 consecutive control subjects (f= 25, m= 15) with normal renal function.

Mean age of hemodialysis and control patients was 56 ± 14 and 47 ± 15 years respectively.

[Table 1] summarized the signs and symptoms of upper GI tract of participants.

In this study a significant difference of GI signs and symptoms between two groups were found (Chi-Square = 15, p= 0.005).

In the microscopic examination of the tissue for H. pylori, no significant difference of H. pylori infection between two groups was seen (70% in HD patients and 57.5% in control group; p= 0.245).

The microscopic examination of gastric fun­dus and gastric body showed no significant difference of H. pylori infection (p= 0.651 and p= 1, respectively). Tissue evaluation of gastric antrum however, showed significant difference, 57.5% versus 32.5% (p= 0.025) [Table 2].


   Discussion Top


This study showed no significant difference of H. pylori infection among non ulcer dyspepsic patients who were undergoing maintenance hemodialysis compared to the patients who had normal renal function with various UGI complaints. The histopathological examination of gastric antrum showed higher localization of H. pylori in HD patients in contrast to con­trol subjects.

Helicobacter pylori has been reported to play an important role in the development of gas­tritis and gastric ulcer. [2] In a study conducted by Davenport et al on 76 patients with end­stage renal failure receiving regular hemodia­lysis found the prevalence of H. pylori Ig G antibodies did not differ significantly from that in 247 age-matched healthy controls. [11] In accor­dance with our findings, a study in patients with dyspeptic complaints consisting of 47 he­modialysis and 100 non-renal disease patients, Ozgur et al. showed that the H. pylori pre­valence among the two groups were not signi­ficantly differ. [12] Similalry Yildiz et al in forty­seven dialysis patients and 55 healthy indivi­duals found no significant difference of H. pylori infection by serum H. Pylori antibody test. [13] Al-Mueilo also studied Fifty-four stable chronic HD patients and 60 consecutive pa­tients with normal renal function underwent upper GI endoscopy and multiple antral gastric biopsies for histological examination to detect H. pylori were obtained. The study did not find any difference between the two groups. [14] Taken together, the above mentioned studies showed no significant differences of H. pylori infection between dialysis and normal kidney function patients. Our study was performed selectively on non-ulcer dyspepsia patients to observe the association between the symptoms and pre­sence of H Pylori. More localization of H. pylori in the antrum of hemodialysis patients was observed in contrast to patients with UGI symptoms and normal renal function. Does this correlate with more dyspepsic symptoms or possibility of ulcer related dyspepsia in future needs to be clarified further in a larger study.

In conclusion, our new finding of higher lo­calization of H. Pylori in the gastric antrum in patients undergoing maintenance hemodialysis needs further evaluation.


   Acknowledgement Top


This study was granted by the research deputy of the Shahrekord University of Medical Sciences, Iran.

 
   References Top

1.Blaser MJ. Helicobacter pylori: Its role in disease. Clin Infect Dis 1992;15:386-93.  Back to cited text no. 1  [PUBMED]  
2.Nakajima F, Sakaguchi M, Oka H, et al. Preva­lence of Helicobacter pylori antibodies in long­term dialysis patients. Nephrology 2004;9(2): 73-6.  Back to cited text no. 2    
3.Nardone G, Rocco A, Fiorillo M, et al. Gastro-duodenal lesions and Helicobacter pylori infection in dyspeptic patients with and with­out chronic renal failure. Helicobacter 2005;10 (1):53-8.  Back to cited text no. 3    
4.Fabbian F, Catalano C, Bordin V, Balbi T, Di Landro D. Esophagogastroduodenoscopy in chronic hemodialysis patients: 2-year clinical experience in a renal unit. Clin Nephrol 2002; 58(1):54-9.  Back to cited text no. 4    
5.Emir S, Bereket G, Boyacioglu S, Varan B, Tunali H, Haberal M. Gastroduodenal lesions and Helicobacter pylori in children with end­stage renal disease. Pediatr Nephrol Dis 2000; 14(8-9):837-40.  Back to cited text no. 5    
6.Moustafa FE, Khalil A, Abdel Wahab M, Sobh MA. Helicobacter pylori and uremic gastritis: A histopathologic study and a correlation with endoscopic and bacteriologic findings. Am J Nephrol 1997;17(2):165-71.  Back to cited text no. 6    
7.Tsukada K, Miyazaki T, Katoh H, et al. Helicobacter pylori infection in hemodialysis patients. Hepatogastroenterology 2003;50(54) :2255-8.  Back to cited text no. 7    
8.Kang JY. The gastrointestinal tract in uremia. Dig Dis Sci 1993;38:257-68.  Back to cited text no. 8  [PUBMED]  
9.Dooley CP, Cohen H, Fitzgibbons PL, et al. Prevalence of Helicobacter pylori infection and histologic gastritis in asymptomatic persons. N Engl J Med 1989;321:1562-6.  Back to cited text no. 9  [PUBMED]  
10.Peterson WL. Helicobacter pylori and peptic ulcer disease. N Engl J Med 1991;324:1043-8.  Back to cited text no. 10  [PUBMED]  
11.Davenport A, Shallcross TM, Crabtree JE, Davison AM, Will EJ, Heatley RV. Prevalence of Helicobacter pylori in patients with end­stage renal failure and renal transplant recipients. Nephron 1991;59(4):597-601.  Back to cited text no. 11    
12.Ozgur O, Boyacioglu S, Ozdogan M, Gur G, Telatar H, Haberal M. Helicobacter pylori infection in haemodialysis patients and renal transplant recipients. Nephrol Dial Transplant 1997;12(2):289-91.  Back to cited text no. 12    
13.Yildiz A, Besisik F, Akkaya V, et al. Helicobacter pylori antibodies in hemodialysis patients and renal transplant recipients. Clin Transplant 1999;13(1.1):13-6.  Back to cited text no. 13    
14.Al-Mueilo SH. Gastro-duodenal lesions and Helicobacter pylori infection in hemodialysis patients. Saudi Med J 2004;25(8):1010-4.  Back to cited text no. 14    

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Correspondence Address:
Hamid Nasri
Department of Internal Medicine, Hajar Medical, Educational and Therapeutic Center, Shahrekord University of Medical Sciences, Shahrekord
Iran
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PMID: 19237808

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    Tables

  [Table 1], [Table 2]

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    Abstract
    Introduction
    Patients and Methods
    Results
    Discussion
    Acknowledgement
    References
    Article Tables
 

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