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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 : 4  |  Page : 579-580
Helicobacter Pylori Infection in Dialysis Patients Undergoing Kidney Transplantation


Department of Gastroenterology Second Medical Clinic, Aristotle University of Thessaloniki, Ippokration Hospital, Thessaloniki, Greece

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How to cite this article:
Zavos C, Kountouras J, Chatzopoulos D. Helicobacter Pylori Infection in Dialysis Patients Undergoing Kidney Transplantation . Saudi J Kidney Dis Transpl 2006;17:579-80

How to cite this URL:
Zavos C, Kountouras J, Chatzopoulos D. Helicobacter Pylori Infection in Dialysis Patients Undergoing Kidney Transplantation . Saudi J Kidney Dis Transpl [serial online] 2006 [cited 2021 Jul 25];17:579-80. Available from: https://www.sjkdt.org/text.asp?2006/17/4/579/32501
Dear editor,

We have read with interest the letter to the editor of Dr Mukhtar and colleagues, and their suggestion that all patients awaiting a renal transplant should be preemptively screened and treated for  Helicobacter pylori Scientific Name Search ori) infection. [1] The authors reported a high prevalence of up to 80% of H. pylori colonization in renal transplant recipients; However, recent data shows that the incidence of peptic ulcer in these patients is only 3%,[2] and that H. pylori infection seems to be less frequent than in the general population.[3],[4],[5] Potential reasons for this low prevalence include spontaneous seroconversion of H. pylori in up to 29% owing to long-standing immunosuppression,[3] or due to a defect in humoral immunity and a decrease in antibody response caused by concurrent medications or the high urea concentration observed in renal transplant recipients.[4],[5]

We agree with the authors' comment that upper gastrointestinal mucosal lesions are common in patients with renal transplants with H. pylori being an important factor contributing to peptic ulcer disease. However, it should be noted that the case presented herein was under immunosuppressive medications that included mycophenolate mofetil shown to display a similar side-effect profile to non­steroidal anti-inflammatory drugs (NSAIDs) such as development of gastritis, duodenitis, esophagitis or ulcers,[6] with 3-8% cases of ulcer perforation or bleeding within 6 months.[7] Moreover, the patient received corticosteroids whose role in directly causing peptic ulcer disease may be controversial, but when com­bined with NSAIDs (in the present case with mycophenolate mofetil possessing a similar profile) they delay the healing of lesions caused by NSAIDs.[8] Therefore, we propose that the severe erosive antral gastritis, erosive duodenitis and anterior wall duodenal ulcer revealed by the second upper gastrointestinal (GI) endoscopy should not only be attributed to the existent H. pylori infection but also to the concurrent immunosuppressive medications.

From a further point of view, during the period between the two upper GI endoscopies, the patient was treated with omeprazole, an agent found to inhibit cyclosporine A metabolism, thereby increasing its serum concentration.[9] It would be interesting to know if the authors had monitored carefully the trough level of cyclosporine A during the initial omeprazole and the later H. pylori eradication therapies.

 
   References Top

1.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 Transplant 2006;17(2):232-3.  Back to cited text no. 1    
2.Weisdorf-Schindele S, Lake JR. Gastrointe­stinal complications of solid and hemato­poietic cell transplantation. In: Feldman M, Friedman LS, Sleisenger MH, Scharschmidt BF (eds). Sleisenger and Fordtran's Gastro­intestinal and Liver Disease. 7 th Edn, Phila­delphia, PA: WB Saunders, 2002;473-86.  Back to cited text no. 2    
3.Sarkio S, Rautelin H, Halme L. The course of Helicobacter pylori infection in kidney transplantation patients. Scand J Gastro­enterol 2003;38(1):20-6.  Back to cited text no. 3    
4.Korzonek M, Szymaniak L, Giedrys­Kalemba S, Ciechanowski K. Is it necessary to treat Helicobacter pylori infection in patients with end-stage renal failure and in renal transplant recipients? Pol Arch Med Wewn 2004;111(3):297-304.  Back to cited text no. 4    
5.Yildiz A, Besisik F, Akkaya V, et al. Helicobacter pylori antibodies in hemodia­lysis patients and renal transplant recipients. Clin Transplant 1999;13(1 Pt 1):13-6.  Back to cited text no. 5    
6.Hebert MF, Ascher NL, Lake JR, et al. Four-year follow-up of mycophenolate mofetil for graft rescue in liver allograft recipients. Transplantation 1999;67(5):707-12.  Back to cited text no. 6    
7.Bjarnason I. Enteric coating of myco­phenolate sodium: a rational approach to limit topical gastrointestinal lesions and extend the therapeutic index of mycopheno­late. Transplant Proc 2001;33(7-8):3238-40.  Back to cited text no. 7    
8.Weil J, Langman MJ, Wainwright P, et al. Peptic ulcer bleeding: accessory risk factors and interactions with non-steroidal anti­inflammatory drugs. Gut 2000;46(1):27-31.  Back to cited text no. 8    
9.Fujiwara T, Hamazaki K, Ikeda Y, et al. Helicobacter pylori infection in renal transplant recipients. Transplant Proc 2000;32(7):1976-8.  Back to cited text no. 9    

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Correspondence Address:
Christos Zavos
Department of Gastroenterology Second Medical Clinic, Aristotle University of Thessaloniki, Ippokration Hospital, Thessaloniki
Greece
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PMID: 17186698

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