Natural Course of <b><i>Helicobacter pylori</i></b> Infection in Japanese Hemodialysis Patients

Abstract

Introduction:Helicobacter pylori (H. pylori) infection is one of the major risk factors for gastrointestinal morbidity in hemodialysis patients. Primary end point is to investigate H. pylori infection rate in hemodialysis patients. As secondary end point, we clarified whether pepsinogen (PG) level was related with H. pylori infection status in hemodialysis patients. Methods: Serum levels of PG I, II, and anti-H. pylori IgG antibody were assessed in 500 Japanese hemodialysis patients. Results:H. pylori infection rate was 15.0% (75/500; 95% CI 12.0-18.4). The duration of hemodialysis in H. pylori-positives was 4.6 ± 3.8 years, which was significantly shorter than in H. pylori-negatives (7.3 ± 6.9, p = 0.001). PG I levels positively correlated with the PG II level and PG I/II ratio (|R| = 0.661, p < 0.001, and |R| = 0.544, p <0.001, respectively). Using a cutoff value of 7.75, the sensitivity and specificity of PG I/II ratio for predicting H. pylori-negatives were 86.3 and 87.8%, respectively (area under the curve 0.930). Conclusions: In hemodialysis patients, infection rate with H. pylori was <20%, with lower rates in patients receiving hemodialysis for longer terms. A PG I/II ratio with a cutoff value of 7.75 may be useful for screening for H. pylori status.

Gender Differences in Plasma Ghrelin Levels in Hemodialysis Patients

“…Decrease of PG I and PG I/II ratio is associated with gastric atrophy. We confirmed that PG I and II were useful in HD patients in our previous study .…”

“…Measurement of serum PG level is useful for the detection of gastric mucosal atrophy, especially in gastric corpus, and has been used as a screening method for gastric cancer and risk assessment. Although serum PG level is elevated in patients with renal failure due to decreased renal clearance of PG, our previous studies suggested that PG I and II levels and PG I/II ratio decreased according to the severity of gastric atrophy, and PG I/II ratio higher than 7.75 might predict H. pylori negativity in HD patients . In general, the prevalence of gastric atrophy increases with advancing age and is similar between men and women .…”

Nutrition status andHelicobacter pyloriinfection in patients receiving hemodialysis

“…A large-scale Japanese epidemiological study showed that the infection rate in Japanese has declined to 30%-50%, especially in younger patients[ 26 ]. Supporting this phenomenon, an investigation of 500 Japanese HD patients with a mean treatment duration of 6.9 ± 6.6 years (2015) reported that the prevalence of infection had dramatically decreased, to 15.0% (95%CI: 12.0-18.4)[ 27 ]. Although it has not yet been proven, decreasing rates of H. pylori infection suggest that the incidence of peptic ulcer disease and gastric cancer is expected to be decreasing in HD patients and that QOL in HD patients has improved due to decreases in H. pylori- related gastrointestinal disease.…”

“…There is an inverse relationship between H. pylori infection and dialysis treatment duration (Table 1 )[ 20 , 27 - 31 ]. We showed that the duration of HD treatment in H. pylori- positive patients was 4.6 ± 3.8 years, which is significantly shorter than that in H. pylori- negatives (7.3 ± 6.9 years, P = 0.001)[ 27 ].…”

“…There is an inverse relationship between H. pylori infection and dialysis treatment duration (Table 1 )[ 20 , 27 - 31 ]. We showed that the duration of HD treatment in H. pylori- positive patients was 4.6 ± 3.8 years, which is significantly shorter than that in H. pylori- negatives (7.3 ± 6.9 years, P = 0.001)[ 27 ]. Interestingly, the finding of decreased H. pylori infection is characteristic of the prevalence of infection decreasing when the treatment period is ≥ 2 year[ 28 ], and the infection rate gradually decreases up to four years after the initiation of HD and is followed by a plateau[ 20 ].…”