Cross-sectional small intestinal surveillance of maintenance hemodialysis patients using video capsule endoscopy: SCHEMA study

Abstract

Background and study aims: Small intestinal pathology in hemodialysis (HD) patients has been studied in only a small number of retrospective case series. One method for noninvasively surveying small intestinal disorders is video capsule endoscopy (VCE). The primary aim of this study was to investigate the prevalence of small intestinal abnormalities among asymptomatic maintenance HD outpatients using VCE. The secondary aim was to assess the clinical impact of these abnormalities. Patients and methods: This study consisted of two phases. In phase I, a cross-sectional study, a cohort of patients who received maintenance HD three times weekly at an outpatient hemodialysis clinic were studied using VCE. Phase II was a prospective cohort study with follow up for 1 year after VCE. Results: Fifty-six patients were enrolled in this study, and two were excluded from analysis due to capsule retention in the stomach. The prevalence of small bowel abnormalities in HD patients was 64.8 % (35/54) (95 % confidential interval 52.1 % – 77.6 %). Of 54 patients, 21 (38.9 %) had mucosal lesions, 10 (18.5 %) had vascular lesions, and 4 (7.4 %) had both lesion types. During the 1-year follow-up period, events occurred in four patients. A small bowel-associated event was observed in one patient, who underwent laparoscopy-assisted small intestinal partial resection 3 months after diagnosis by VCE. All patients in whom events were seen had small bowel abnormalities; no events were observed in the VCE-negative group. Conclusions: Although asymptomatic maintenance HD patients had a high prevalence of small bowel abnormalities (64.8 %), they did not have a high incidence of small bowel-associated events during the 1-year follow-up.

Proton Pump Inhibitors and Hyporesponsiveness to Erythropoiesis-Stimulating Agents in Hemodialysis Patients: Results from the Japan Dialysis Outcomes and Practice Patterns Study

“…Fifth, although the diagnosis of gastrointestinal bleeding was adjusted in the analysis model as a past history, it cannot be denied that latent and asymptomatic chronic bleeding was a confounding factor. The effects may be minimal as occult bleeding has been reported to be low in hemodialysis patients [50]. However, it cannot be said with certainty that there will be no impact.…”

Usefulness of Castor Oil and Elobixibat and Lactulose and ascorbic Aid for Bowel Preparation for Colon Capsule Endoscopy-Initial examination

“…A previous study reported that ESRD patients tend to have various gastrointestinal lisions and associated complication [1] . In addition,the incidence of vascular lesions such as angioectasia has also been reported to be increases in these patients [2,3,4] . Colon capsule endoscopy [5,6,7] was approved for reimbursement under the national health insurance system of Japan in 2014.…”

Feeling gutted in chronic kidney disease (CKD): Gastrointestinal disorders and therapies to improve gastrointestinal health in individuals CKD, including those undergoing dialysis

“…24 Finally, using video capsule endoscopy, $40% of the studied individuals undergoing hemodialysis had mucosal lesions, including erosions and ulcers; however, biopsies were not included to assess intestinal barrier components. 25 F I G U R E 2 The intestinal barrier in health and chronic kidney disease. In the absence of chronic kidney disease (left panel), the components of the intestinal barrier function (i.e., mucus layer; epithelial layer connected by the correct configuration of JAMs, claudins, and occludins; and mucosal immune system located in the lamina propria) work in tandem to maintain homeostasis.…”