Improvement of gastric motility by hemodialysis in patients with chronic renal failure

Abstract

Background: Gastrointestinal (GI) symptoms are common in patients with chronic renal failure (CRF). We have previously demonstrated that patients with predialysis endstage renal disease showed a high prevalence of GI symptoms and gastric hypomotility, and that gastric hypomotility appears to be an important factor in generating GI symptoms. However, it is not clear whether impaired gastric motor function would improve after hemodialytic treatment. Aims: To examine the relationship between gastric motor function and GI symptoms in CRF patients on hemodialysis. Methods: The study was performed in 19 patients with CRF treated with hemodialysis for more than six months and in 12 matched healthy controls. GI symptom severity was quantified in all patients. Gastric motility was evaluated with cutaneously recorded electrogastrography (EGG) and gastric emptying of semi-solid meals using the 13 C-acetic acid breath test. Results: Six patients had no symptoms, and 11 had slight GI symptoms with a total symptom score of less than 5. Compared with controls, CRF patients revealed no differences in gastric motility parameters, with the exception of a lower percentage of normogastria in EGG at fasting state. Eleven patients had normal gastric motor function (Group A), and eight showed abnormalities of either gastric myoelectrical activity or gastric emptying (Group B). There was no difference in symptom score between Group A and Group B. Conclusions: More than half of the patients with CRF on hemodialysis demonstrated normal gastric motility, and no or slight GI symptoms. Hemodialytic treatment may improve impaired gastric motility and reduce GI symptoms in patients with CRF.

Effects of Chronic Renal Failure on Gastrointestinal Motility: A Study on the Changes of Gastric Emptying, Small Intestinal Transit, Interdigestive Myoelectric Complex, and Fecal Water Content

“…[22][23][24][25][26][27][28] Why CRF often induces the problems of GI motility is still unclear and even paradoxical sometimes. For instance, Hiroshi et al 28 proved that hemodialysis could improve the GI symptoms in CRF patients, while Wu et al 20 reported that these symptoms often occur in the CRF patients treated by long-term hemodialysis. In general, GE, CTT, and gastric MMC are dependent on autonomic (parasympathetic) nerves.…”

Neurological complications of chronic kidney disease

“…38 Other clinical manifestations may include gastrointestinal complications, such as impaired gastric motility and dyspepsia, impaired sudomotor function and intradialytic hypotension. 27,34,39 Patients with cardiovascular autonomic dysfunction may exhibit orthostatic intolerance, cardiac arrhythmia and reduced capacity for exercise. Cardiac autonomic dysfunction is potentially life-threatening with manifestations such as cardiac arrhythmia, silent myocardial ischemia and sudden cardiac death.…”

“…38 Gastrointestinal complications such as impaired motility may improve with haemodialysis. 39 Intradialytic hypotension may be improved with midodrine; an alpha 1-receptor agonist producing an increase in vascular tone, administered prior to dialysis. Modifiable risk factors that may reduce intradialytic hypertension episodes include a low dry weight and hypertension.…”

Evaluation of electrical activity after vagus nerve-preserving distal gastrectomy using multichannel electrogastrography

“…In patients with unresectable cancer, the severity of symptoms was significantly higher in patients with abnormal EGG results (28). On the other hand, some investigators reported no correlation was observed between EGG parameters and symptoms (34,35,36,37). As different methods have been applied in various investigations, there is only limited comparability.…”