This study aimed to determine the prevalence of endoscopic and histological gastroduodenitis as well as helicobacter-like organisms in patients with end stage renal failure undergoing maintenance dialysis treatment. A total of 322 out of 422 patients in our dialysis programme underwent endoscopy and gastroduodenal biopsy specimens were taken from 260. Endoscopic gastroduodenitis occurred in 158 (49%). Histological gastritis occurred in the gastric body or antrum in 134 patients (52%) and duodenitis in 52 (21%). There was no correlation between endoscopic and histological gastritis in contrast to a significant correlation for duodenitis. Helicobacter-like organisms occurred in the body or antrum in 81 (31%). Their presence was associated with gastritis -in particular acute and acute on chronic gastritis rather than chronic gastritis. Patients with gastritis were significantly older than those without (p<0001) and had lower basal and peak acid outputs. Although we now know that uraemic patients on maintenance dialysis treatment are not especially prone to develop peptic ulcer,' the frequency of complicated ulcer disease does seem to be increased after kidney transplantation.67 Helicobacter pylori is associated with both peptic ulcer and gastritis, and a causal role has been postulated for the bacterium in both conditions.81' The prevalence of gastritis and gastric helicobacter in uraemia is therefore of interest. Although gastroduodenitis has been studied in several series of uraemic patients,' 12-16 the prevalence of gastric helicobacter in uraemia has not, to our knowledge, been reported before. We therefore investigated the relation between histological gastroduodenitis and helicobacter-like organisms in a large series of patients with end stage renal failure undergoing maintenance dialysis treatment.
Methods
In the present double-blind placebo-controlled study the effect of cisapride on functional dyspepsia was evaluated in patients with and without histological gastritis. Patients with functional dyspepsia and whose symptoms persisted after a 2 week run-in period with antacid treatment were randomized to receive cisapride (10 mg) or matching placebo three times daily for 4 weeks. Symptoms of epigastric pain, bloating, nausea, belching, early satiety and heartburn were graded on a four-point scale based on patients' feedback and diary card recording. A global response was also formulated by the investigators. One hundred and four patients entered the study and 76 completed the trial, comprising 36 patients with histological gastritis and 40 patients without gastritis. Symptom scores in both gastritis and non-gastritis groups were significantly improved by both cisapride and placebo; however, the improvement was not statistically different between the two treatment groups. Cisapride produced a good or better global response in 58% of subjects with histological gastritis and in 53% of subjects without gastritis compared with 47% and 52%, respectively, of patients on placebo; this difference was not statistically significant. Gastric histology did not influence the effect of cisapride on the symptoms of functional dyspepsia.
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