Upper gastrointestinal alterations in kidney transplant candidates

Netto, João Pedro Homse; Pinheiro, João Pedro Sant'Anna; Ferrari, Mariana Lopes; Soares, Mirella Tizziani; Silveira, Rogério Augusto Gomes; Maioli, M.; Delfino, Vinícius Daher Alvares

doi:10.1590/2175-8239-jbn-3829

Cited by 11 publications

(10 citation statements)

References 21 publications

(26 reference statements)

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“…Endoscopy and histological changes in the upper gastrointestinal tract of patients with chronic renal failure were studied by Mirsa et al30 who showed that the most frequent histological changes in gastric histology were mucosal edema (82.35%) and gastritis (23.5%). Homse Netto et al22 conducted a study of 96 patients to evaluate gastrointestinal alterations in renal transplant candidates, and found that intestinal metaplasia was present in 8.33% of their population, which was most consistent with our study. But in this study, H. pylori was significantly associated with non-ulcerative gastric findings, which was not consistent with our study.…”

Section: Discussionsupporting

confidence: 90%

“…H. pylori infection has been reported to be strongly associated with various gastroduodenal diseases 11,15. The prevalence of H. pylori infection in the study differs from country to country, ethnicity to ethnicity, even in the same country 12,20–22. Our study revealed that 50.2% of our population were H. pylori positive, which was lower and at the same time higher compared to local and international studies.…”

Section: Discussioncontrasting

confidence: 58%

“…Given these limitations and to determine the significance of our results, multi-center research can be used. Compared to other studies,22 one of the strengths of our study was the significant size of the sample with important variables available including pre-transplant laboratory data, endoscopy, and histological reports. Another strength of our study was that endoscopic and histologic findings were classified into different groups and the frequency of H. pylori infection was evaluated in different types of endoscopic and histological findings.…”

Section: Discussionmentioning

confidence: 99%

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Helicobacter pylori, Endoscopic, And Histologic Features Among Kidney Transplant Candidates In Southern Iran

Niknam¹,

Barfei²,

Mahmoudi³

2019

IDR

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BackgroundThe risks of gastrointestinal disorders and cancer are higher in chronic kidney disease (CKD) patients than the general population. There are only a few published reports on the association of helicobacter pylori (H. pylori) infection, endoscopic findings, and histology in these patients. This study was designed to address these controversial topics among kidney transplant candidates as the first study in southern Iran.Patients and methodsIn this cross-sectional study, patients undergoing renal transplantation in the largest center of southern Iran during 2016–2017 were evaluated for the frequency of H. pylori infection, endoscopic findings, and histology. Gastric endoscopic findings (normal, abnormal non-ulcerative, ulcerative) and histological findings of gastric biopsy (normal/non-significant, inflammation, premalignant lesions (PMLs), malignant lesions) were studied.ResultsIn total, 293 patients underwent endoscopy for transplant work up. The mean age (SD) was 47.37 (13.14) years. The most common endoscopic finding was abnormal gastric lesions. Overall, 78.8% patients had abnormal gastric histologic findings, of which 6.1% had PMLs. There was no significant association between laboratory data of patients with H. pylori infection. Of these, 147 (50.2%) patients were positive and the others were H. Pylori negative. Positive H. pylori infection was significantly associated with gastric ulcerative lesions. Positive H. pylori infection was also strongly associated with inflammation (P<0.01), but not significantly associated with PMLs (P=0.99) in gastric histology.ConclusionThe present study showed that abnormal endoscopic and histologic findings as well as positive H. pylori infection were observed in a large number of kidney transplant candidates, so upper endoscopy with biopsy is an acceptable procedure for these patients. However, further studies are recommended to determine the relationship of H. pylori with abnormal endoscopic and histologic findings considering other confounding factors in kidney transplant candidates as well as the efficacy of H. pylori eradication therapy to improve these abnormal findings.

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Section: Discussionsupporting

confidence: 90%

Section: Discussioncontrasting

confidence: 58%

Section: Discussionmentioning

confidence: 99%

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Helicobacter pylori, Endoscopic, And Histologic Features Among Kidney Transplant Candidates In Southern Iran

Niknam¹,

Barfei²,

Mahmoudi³

2019

IDR

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“…In 5161 dialysis patients (3804 HD and 1507 PD), the most prevalent symptoms were constipation, indigestion, abdominal pain and reflux [ 18 ]. However, there is no good correlation between the symptoms of the patients and endoscopic gastroduodenal lesions [ 19 , 20 ]. In one study, 73.8% of the patients were asymptomatic, whereas 35.9% of the patients had normal endoscopy [ 20 ].…”

Section: Discussionmentioning

confidence: 99%

Comparison of endoscopic and pathological findings of the upper gastrointestinal tract in transplant candidate patients undergoing hemodialysis or peritoneal dialysis treatment: a review of literature

et al. 2020

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Background Dyspepsia is a common disorder in kidney transplant recipients, and the risk of post-transplant complications is increased in candidates with upper gastrointestinal disease. We evaluated gastrointestinal lesions of kidney transplant candidates on dialysis. Methods In this study, endoscopic and pathological findings in hemodialysis (HD) and peritoneal dialysis (PD) patients with gastrointestinal symptoms on the waiting list were compared. Results The most common non-ulcerous lesions in the endoscopic examination were gastritis (62.3%), erosive gastritis (38.7%), duodenal erosion or duodenitis (18.9%) and esophagitis (13.2%). The ulcerous lesion was present in only 3 patients. Gastroesophageal reflux disease, ulcerated lesion and non-ulcerated lesion rates were similar in both dialysis groups. Histopathological examination revealed Helicobacter pylori (HP) positivity in 28.3% of patients. HP positivity rate was significantly higher in PD patients than in HD patients (38.7% vs. 13.6%, p = 0.046). Chronic gastritis (75.5%) was the most common pathological finding. HP positivity rate was 37.5% in patients with chronic gastritis, but HP was negative in patients without chronic gastritis. In multivariate analysis, male gender, urea and albumin levels were associated with the presence of pathological chronic gastritis. The presence of gastritis, total cholesterol and ferritin levels were found significant for HP positivity. A total cholesterol > 243 mg/dL was significantly related to an increased risk of the presence of HP positivity. Conclusions Gastrointestinal lesions and HP infection are common in dialysis patients. Dialysis modality may affect the frequency of some lesions. It may be useful to have an endoscopic examination before entering the transplant waiting list for all candidates.

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“…GI discomfort is a common symptom following renal transplantation and can be caused by various immunosuppressive medications [ 15 , 21 ]. While taking a toll on quality of life, GI symptoms can eventually lead to poor graft survival and increased mortality [ 15 ].…”

Section: Reviewmentioning

confidence: 99%

Uremic and Post-Transplant Gastropathy in Patients With Chronic Kidney Disease and End-Stage Renal Disease

Turshudzhyan¹,

Inyangetor²

2020

Cureus

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Gastrointestinal (GI) mucosal lesions are common in chronic kidney disease (CKD), end-stage renal disease (ESRD), and in post-renal transplant period. However, etiology of mucosal lesions pre- and post-transplant is very different. Gastropathy in non-transplant ESRD patients usually develops because of uremia, chronic anemia, and fluctuations in the gastric blood supply during hemodialysis, eventually leading to uremic gastritis. Gastropathy in post-transplant patients tends to be associated with immunosuppressive therapies. Helicobacter pylori infection is more prevalent in uremic patients than in post-transplant patients. Uremia can also lead to uremic arteriolopathy and autonomic nervous system dysfunction, which can present with GI symptoms mimicking uremic gastropathy. Post-transplantation immunosuppressive therapies have been linked to GI mucosal lesions as well. These lesions carry a poor prognostic factor disrupting the function of the GI tract, which in turn affects the pharmacokinetics of the immunosuppressive drugs eventually leading to poor graft survival and increased mortality. Mycophenolate mofetil is one of the agents more associated with intestinal erosions. Recognizing uremic gastropathy and intervening early helps prevent post-transplant GI complications. Acid controlling therapies can be an effective prophylaxis against both gastropathies. Using enteric-coated formulation for immunosuppressive agents may slow down the mucosal insult. Treatment of H. pylori in both patient populations may help prevent further mucosal injury. Lastly, timely screening for symptoms may help start treatment early and prevent progression to serious gastropathy.

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Upper gastrointestinal alterations in kidney transplant candidates

Abstract: Abnormal upper endoscopy findings were detected in all studied patients. This study suggested that upper endoscopy is a valid procedure for kidney transplant candidates. However, prospective studies are needed to shed more light on this matter.

Cited by 11 publications

References 21 publications

<p><em>Helicobacter pylori</em>, Endoscopic, And Histologic Features Among Kidney Transplant Candidates In Southern Iran</p>

<p><em>Helicobacter pylori</em>, Endoscopic, And Histologic Features Among Kidney Transplant Candidates In Southern Iran</p>

Comparison of endoscopic and pathological findings of the upper gastrointestinal tract in transplant candidate patients undergoing hemodialysis or peritoneal dialysis treatment: a review of literature

Uremic and Post-Transplant Gastropathy in Patients With Chronic Kidney Disease and End-Stage Renal Disease

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