Prevalence of asymptomatic gastroduodenal lesions and Helicobacter pylori infection in kidney transplant candidates
Bunchorntavakul, C.; Atsawarungruangkit, A.
Journal of the Medical Association of Thailand 97(Suppl 11): S62-S68
2014
ISSN/ISBN: 0125-2208 PMID: 25509697 Document Number: 16790
Upper gastrointestinal (UGI) diseases are more common in patients with end-stage renal disease (ESRD) compared to general populations. Previous studies demonstrated that ESRD patients with UGI disease are at increased risk for developing complications following kidney transplantation (KT). Prevalence of UGI lesions and Helicobacter pylori in asymptomatic KT candidates remain unclear To evaluate the prevalence of UGI lesions and Helicobacter pylori in nondyspeptic KT candidates. The authors retrospectively and prospectively enrolled consecutive patients with ESRD who underwent esophagogastroduodenoscopy (EGD) as part of pre-KT evaluation at a single tertiary center (Rajavithi Hospital, Bangkok) between 2008 and 2013. Patients with significant dyspeptic symptoms, known UGI disease and received PPI/NSAIDs/antibiotics within two weeks before EGD were excluded. EGD was performed with random biopsies for rapid urease test and histology. In all, 107 ESRD patients were included; 53.0% were men and a median age was 38.7 (15.9-65.0) years. A total of 95% of patients had been on hemodialysis with the median duration of 2.1 (0.2-15.3) years. Significant EGD findings (defined as lesions other than normal and nonerosive gastritis) were encountered in 46% of patients; most lesions were erosive gastroduodenitis and peptic ulcers. Among several baseline demographic and laboratory parameters analyzed, only older age was significantly associated with significant EGD findings (p = 0.026). Helicobacter pylori infection was documented in 27.1% of patients. This prevalence tended to be lower than the prevalence of H. pylori of 39% in 105 sex- and age-matched, nonESRD patients without significant EGD findings who underwent EGD during the same time, but not statistically significant (p = 0.08). The authors demonstrated a considerable prevalence of acid-related UGI diseases and H. pylori infection in nondyspeptic KT candidates. Therefore, EGD is a reasonable part of routine preKT evaluations, at least in our part of the world, to promptly detect and precisely manage the problem.