LETTER TO EDITOR
Year : 2006 | Volume
: 17 | Issue : 2 | Page : 232--233
Should All Dialysis Patients be Screened and Treated for Helicobacter Pylori Preemptively before Renal Transplant?
Attiya Mukhtar1, Tahir Qayyum Malik2, Ayman Karkar2,
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
Department of Medicine, Dammam Central Hospital, P.O. Box 12723, Dammam 31483
|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;17:232-233
|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 2021 Mar 4 ];17:232-233
Available from: https://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.  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.  Gastroduodenal lesions in the H. pylori infected dialysis and allograft recipients include atrophic, superficial, and erosive gastritis and gastric ulcer.  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,  and infected patients experience significantly more frequent upper gastrointestinal symptoms. 
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.
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