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Prevalence of Helicobacter pylori infection in long-term hemodialysis patients

2008; Elsevier BV; Volume: 75; Issue: 1 Linguagem: Inglês

10.1038/ki.2008.508

ISSN

1523-1755

Autores

Mitsushige Sugimoto, Kyoko Sakai, Masakazu Kita, Jirô Imanishi, Yoshio Yamaoka,

Tópico(s)

Potassium and Related Disorders

Resumo

Patients on hemodialysis often have gastrointestinal complications; however, it is unclear if Helicobacter pylori infection is present in these patients. Here we determined the prevalence of H. pylori infection in 539 Japanese hemodialysis patients by measuring serum anti-H. pylori IgG antibodies. Endoscopy was performed on 299 of these patients and the results were compared to 400 patients with normal renal function who had also undergone endoscopy and sero-testing. A second cohort of 478 dialysis patients, within the original group, was checked serologically for H. pylori infection three times over a four-year observation period. The prevalence of infection in these patients was significantly lower than in those patients with normal renal function, irrespective of the clinical outcomes. The prevalence of H. pylori infection significantly decreased as the duration of dialysis increased, particularly within the first four years following initiation of dialysis. About one-third of patients on dialysis for less than four years became serologically negative for H. pylori infection within this observation period. Our study suggests that although long-term dialysis patients have low prevalence of H. pylori, they still have significant gastroduodenal diseases, such as peptic ulcers, that require endoscopic follow-up. Patients on hemodialysis often have gastrointestinal complications; however, it is unclear if Helicobacter pylori infection is present in these patients. Here we determined the prevalence of H. pylori infection in 539 Japanese hemodialysis patients by measuring serum anti-H. pylori IgG antibodies. Endoscopy was performed on 299 of these patients and the results were compared to 400 patients with normal renal function who had also undergone endoscopy and sero-testing. A second cohort of 478 dialysis patients, within the original group, was checked serologically for H. pylori infection three times over a four-year observation period. The prevalence of infection in these patients was significantly lower than in those patients with normal renal function, irrespective of the clinical outcomes. The prevalence of H. pylori infection significantly decreased as the duration of dialysis increased, particularly within the first four years following initiation of dialysis. About one-third of patients on dialysis for less than four years became serologically negative for H. pylori infection within this observation period. Our study suggests that although long-term dialysis patients have low prevalence of H. pylori, they still have significant gastroduodenal diseases, such as peptic ulcers, that require endoscopic follow-up. Helicobacter pylori (H. pylori) is a spiral-shaped Gram-negative flagellate bacterium. Chronic H. pylori infection has close associations with gastrointestinal diseases, such as peptic ulcer (PU), gastric hyperplastic polyps, gastric adenoma, gastric cancer, and gastric mucosa-associated lymphoid tissue lymphoma.1.Uemura N. Okamoto S. Yamamoto S. et al.Helicobacter pylori infection and the development of gastric cancer.N Engl J Med. 2001; 345: 784-789Crossref PubMed Scopus (3427) Google Scholar, 2.Hopkins R.J. Girardi L.S. Turney E.A. Relationship between Helicobacter pylori eradication and reduced duodenal and gastric ulcer recurrence: a review.Gastroenterology. 1996; 110: 1244-1252Abstract Full Text Full Text PDF PubMed Scopus (527) Google Scholar, 3.Wotherspoon A.C. Doglioni C. de Boni M. et al.Antibiotic treatment for low-grade gastric MALT lymphoma.Lancet. 1994; 343: 1503Abstract PubMed Scopus (76) Google Scholar Recently, increased evidence suggests that the development of some extragastrointestinal disorders including idiopathic thrombocytopenic purpura, chronic idiopathic urticaria, and iron deficiency anemia are also related with H. pylori infection of gastric mucosa.4.Gasbarrini A. Franceschi F. Tartaglione R. et al.Regression of autoimmune thrombocytopenia after eradication of Helicobacter pylori.Lancet. 1998; 352: 878Abstract Full Text Full Text PDF PubMed Scopus (362) Google Scholar, 5.Tebbe B. Geilen C.C. Schulzke J.D. et al.Helicobacter pylori infection and chronic urticaria.J Am Acad Dermatol. 1996; 34: 685-686Abstract Full Text PDF PubMed Scopus (128) Google Scholar, 6.Annibale B. Marignani M. Monarca B. et al.Reversal of iron deficiency anemia after Helicobacter pylori eradication in patients with asymptomatic gastritis.Ann Intern Med. 1999; 131: 668-672Crossref PubMed Scopus (185) Google Scholar In these infected patients, the eradication of H. pylori is recommended as the first-line therapy for the prevention and cure of gastroduodenal diseases.1.Uemura N. Okamoto S. Yamamoto S. et al.Helicobacter pylori infection and the development of gastric cancer.N Engl J Med. 2001; 345: 784-789Crossref PubMed Scopus (3427) Google Scholar, 7.Take S. Mizuno M. Ishiki K. et al.The effect of eradicating helicobacter pylori on the development of gastric cancer in patients with peptic ulcer disease.Am J Gastroenterol. 2005; 100: 1037-1042Crossref PubMed Scopus (181) Google Scholar Although there is no significant evidence that H. pylori infection is directly associated with progression of renal dysfunction, patients receiving chronic hemodialysis and continuous ambulatory peritoneal dialysis (CAPD) often incur gastrointestinal troubles over their long treatment period.8.Ala-Kaila K. Upper gastrointestinal findings in chronic renal failure.Scand J Gastroenterol. 1987; 22: 372-376Crossref PubMed Scopus (60) Google Scholar, 9.Sezer S. Ibis A. Ozdemir B.H. et al.Association of Helicobacter pylori infection with nutritional status in hemodialysis patients.Transplant Proc. 2004; 36: 47-49Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar, 10.Sotoudehmanesh R. Ali Asgari A. Ansari R. et al.Endoscopic findings in end-stage renal disease.Endoscopy. 2003; 35: 502-505Crossref PubMed Scopus (51) Google Scholar, 11.Prakash J. Agrawal B.K. Upper gastrointestinal mucosal lesions in chronic renal failure.Indian J Gastroenterol. 1991; 10: 131-132PubMed Google Scholar, 12.Gheissari A. Rajyaguru V. Kumashiro R. et al.Gastrointestinal hemorrhage in end stage renal disease patients.Int Surg. 1990; 75: 93-95PubMed Google Scholar, 13.Tsai C.J. Hwang J.C. Investigation of upper gastrointestinal hemorrhage in chronic renal failure.J Clin Gastroenterol. 1996; 22: 2-5Crossref PubMed Scopus (35) Google Scholar, 14.Khedmat H. Ahmadzad-Asl M. Amini M. et al.Gastro-duodenal lesions and Helicobacter pylori infection in uremic patients and renal transplant recipients.Transplant Proc. 2007; 39: 1003-1007Abstract Full Text Full Text PDF PubMed Scopus (56) Google Scholar, 15.Milito G. Taccone-Gallucci M. Brancaleone C. et al.Assessment of the upper gastrointestinal tract in hemodialysis patients awaiting renal transplantation.Am J Gastroenterol. 1983; 78: 328-331PubMed Google Scholar, 16.Milito G. Taccone-Gallucci M. Brancaleone C. et al.The gastrointestinal tract in uremic patients on long-term hemodialysis.Kidney Int. 1985; 17: S157-S160Google Scholar, 17.Musola R. Franzin G. Mora R. et al.Prevalence of gastroduodenal lesions in uremic patients undergoing dialysis and after renal transplantation.Gastrointest Endosc. 1984; 30: 343-346Abstract Full Text PDF PubMed Scopus (32) Google Scholar Patients with chronic renal failure (CRF) present with various clinical symptoms, including nausea, dyspepsia, appetite loss, epigastric discomfort, and heartburn, as well as histological, physiological, and functional disorders of the gastrointestinal system.18.Var C. Gultekin F. Candan F. et al.The effects of hemodialysis on duodenal and gastric mucosal changes in uremic patients.Clin Nephrol. 1996; 45: 310-314PubMed Google Scholar, 19.Kang J.Y. Ho K.Y. Yeoh K.G. et al.Peptic ulcer and gastritis in uraemia, with particular reference to the effect of Helicobacter pylori infection.J Gastroenterol Hepatol. 1999; 14: 771-778Crossref PubMed Scopus (40) Google Scholar These symptoms not only decrease the quality of life of patients, but also may affect their nutrition status, thus contributing to the development of malnutrition, which is a potent predictor of morbidity and mortality in patients with CRF. Moreover, 25–75% of patients with CRF undergoing dialysis suffer from a number of gastrointestinal lesions and their complications (for example, gastric erosions, PUs, angiodysplasia, and gastrointestinal bleeding).8.Ala-Kaila K. Upper gastrointestinal findings in chronic renal failure.Scand J Gastroenterol. 1987; 22: 372-376Crossref PubMed Scopus (60) Google Scholar, 9.Sezer S. Ibis A. Ozdemir B.H. et al.Association of Helicobacter pylori infection with nutritional status in hemodialysis patients.Transplant Proc. 2004; 36: 47-49Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar, 10.Sotoudehmanesh R. Ali Asgari A. Ansari R. et al.Endoscopic findings in end-stage renal disease.Endoscopy. 2003; 35: 502-505Crossref PubMed Scopus (51) Google Scholar, 11.Prakash J. Agrawal B.K. Upper gastrointestinal mucosal lesions in chronic renal failure.Indian J Gastroenterol. 1991; 10: 131-132PubMed Google Scholar, 12.Gheissari A. Rajyaguru V. Kumashiro R. et al.Gastrointestinal hemorrhage in end stage renal disease patients.Int Surg. 1990; 75: 93-95PubMed Google Scholar, 13.Tsai C.J. Hwang J.C. Investigation of upper gastrointestinal hemorrhage in chronic renal failure.J Clin Gastroenterol. 1996; 22: 2-5Crossref PubMed Scopus (35) Google Scholar, 14.Khedmat H. Ahmadzad-Asl M. Amini M. et al.Gastro-duodenal lesions and Helicobacter pylori infection in uremic patients and renal transplant recipients.Transplant Proc. 2007; 39: 1003-1007Abstract Full Text Full Text PDF PubMed Scopus (56) Google Scholar, 15.Milito G. Taccone-Gallucci M. Brancaleone C. et al.Assessment of the upper gastrointestinal tract in hemodialysis patients awaiting renal transplantation.Am J Gastroenterol. 1983; 78: 328-331PubMed Google Scholar, 16.Milito G. Taccone-Gallucci M. Brancaleone C. et al.The gastrointestinal tract in uremic patients on long-term hemodialysis.Kidney Int. 1985; 17: S157-S160Google Scholar, 17.Musola R. Franzin G. Mora R. et al.Prevalence of gastroduodenal lesions in uremic patients undergoing dialysis and after renal transplantation.Gastrointest Endosc. 1984; 30: 343-346Abstract Full Text PDF PubMed Scopus (32) Google Scholar, 20.Wee A. Kang J.Y. Ho M.S. et al.Gastroduodenal mucosa in uraemia: endoscopic and histological correlation and prevalence of helicobacter-like organisms.Gut. 1990; 31: 1093-1096Crossref PubMed Scopus (51) Google Scholar H. pylori infection is crucial in many gastrointestinal conditions not only in individuals with normal renal function, but also in CRF patients receiving chronic dialysis, CAPD, and kidney transplant. Recently, although associations between patients with CRF and the prevalence of H. pylori infection have been reported,9.Sezer S. Ibis A. Ozdemir B.H. et al.Association of Helicobacter pylori infection with nutritional status in hemodialysis patients.Transplant Proc. 2004; 36: 47-49Abstract Full Text Full Text PDF PubMed Scopus (25) Google Scholar, 10.Sotoudehmanesh R. Ali Asgari A. Ansari R. et al.Endoscopic findings in end-stage renal disease.Endoscopy. 2003; 35: 502-505Crossref PubMed Scopus (51) Google Scholar, 11.Prakash J. Agrawal B.K. Upper gastrointestinal mucosal lesions in chronic renal failure.Indian J Gastroenterol. 1991; 10: 131-132PubMed Google Scholar, 12.Gheissari A. Rajyaguru V. Kumashiro R. et al.Gastrointestinal hemorrhage in end stage renal disease patients.Int Surg. 1990; 75: 93-95PubMed Google Scholar, 13.Tsai C.J. Hwang J.C. Investigation of upper gastrointestinal hemorrhage in chronic renal failure.J Clin Gastroenterol. 1996; 22: 2-5Crossref PubMed Scopus (35) Google Scholar, 14.Khedmat H. Ahmadzad-Asl M. Amini M. et al.Gastro-duodenal lesions and Helicobacter pylori infection in uremic patients and renal transplant recipients.Transplant Proc. 2007; 39: 1003-1007Abstract Full Text Full Text PDF PubMed Scopus (56) Google Scholar, 21.Offerhaus G.J. Kreuning J. Valentijn R.M. et al.Campylobacter pylori: prevalence and significance in patients with chronic renal failure.Clin Nephrol. 1989; 32: 239-241PubMed Google Scholar, 22.Shousha S. Arnaout A.H. Abbas S.H. et al.Antral Helicobacter pylori in patients with chronic renal failure.J Clin Pathol. 1990; 43: 397-399Crossref PubMed Scopus (47) Google Scholar, 23.Ala-Kaila K. Vaajalahti P. Karvonen A.L. et al.Gastric Helicobacter and upper gastrointestinal symptoms in chronic renal failure.Ann Med. 1991; 23: 403-406Crossref PubMed Scopus (33) Google Scholar, 24.Davenport A. Shallcross T.M. Crabtree J.E. et al.Prevalence of Helicobacter pylori in patients with end-stage renal failure and renal transplant recipients.Nephron. 1991; 59: 597-601Crossref PubMed Google Scholar, 25.Loffeld R.J. Peltenburg H.G. vd Oever H. et al.Prevalence of Helicobacter pylori antibodies in patients on chronic intermittent haemodialysis.Nephron. 1991; 59: 250-253Crossref PubMed Google Scholar, 26.Neithercut W.D. Rowe P.A. el Nujumi A.M. et al.Effect of Helicobacter pylori infection on intragastric urea and ammonium concentrations in patients with chronic renal failure.J Clin Pathol. 1993; 46: 544-547Crossref PubMed Scopus (38) Google Scholar, 27.Jaspersen D. Fassbinder W. Heinkele P. et al.Significantly lower prevalence of Helicobacter pylori in uremic patients than in patients with normal renal function.J Gastroenterol. 1995; 30: 585-588Crossref PubMed Scopus (58) Google Scholar, 28.De Vecchi A.F. Quatrini M. Boni F. et al.Epidemiology of Helicobacter pylori in dialysis patients.Perit Dial Int. 1995; 15: 178-179PubMed Google Scholar, 29.Luzza F. Imeneo M. Maletta M. et al.Helicobacter pylori-specific IgG in chronic haemodialysis patients: relationship of hypergastrinaemia to positive serology.Nephrol Dial Transplant. 1996; 11: 120-124Crossref PubMed Google Scholar, 30.Seyrek N. Kocabas E. Hazar S. et al.Helicobacter pylori antibodies in patients on chronic hemodialysis.Nephron. 1996; 72: 725-726Crossref PubMed Scopus (6) Google Scholar, 31.Krawczyk W. Gorna E. Suwala J. et al.Frequency of Helicobacter pylori infection in uremic hemodialyzed patients with antral gastritis.Nephron. 1996; 74: 621-622Crossref PubMed Scopus (6) Google Scholar, 32.Abu Farsakh N.A. Roweily E. Rababaa M. et al.Brief report: evaluation of the upper gastrointestinal tract in uraemic patients undergoing haemodialysis.Nephrol Dial Transplant. 1996; 11: 847-850Crossref PubMed Scopus (48) Google Scholar, 33.Hruby Z. Myszka-Bijak K. Gosciniak G. et al.Helicobacter pylori in kidney allograft recipients: high prevalence of colonization and low incidence of active inflammatory lesions.Nephron. 1997; 75: 25-29Crossref PubMed Scopus (28) Google Scholar, 34.Antoniou S. Dimitriadis A. Kliridou M. et al.Prevalence of Helicobacter pylori antibodies in CAPD patients.Nephron. 1997; 75: 358-359Crossref PubMed Scopus (9) Google Scholar, 35.Moustafa F.E. Khalil A. Abdel Wahab M. et al.Helicobacter pylori and uremic gastritis: a histopathologic study and a correlation with endoscopic and bacteriologic findings.Am J Nephrol. 1997; 17: 165-171Crossref PubMed Scopus (29) Google Scholar, 36.Ozgur O. Boyacioglu S. Ozdogan M. et al.Helicobacter pylori infection in haemodialysis patients and renal transplant recipients.Nephrol Dial Transplant. 1997; 12: 289-291Crossref PubMed Scopus (51) Google Scholar, 37.Munoz de Bustillo E. Sanchez Tomero J.A. Sanz J.C. et al.Eradication and follow-up of Helicobacter pylori infection in hemodialysis patients.Nephron. 1998; 79: 55-60Crossref PubMed Scopus (38) Google Scholar, 38.Fabrizi F. Martin P. Dixit V. et al.Epidemiology of Helicobacter pylori in chronic haemodialysis patients using the new RIBA H. pylori SIA.Nephrol Dial Transplant. 1999; 14: 1929-1933Crossref PubMed Scopus (21) Google Scholar, 39.Araki H. Miyazaki R. Matsuda T. et al.Significance of serum pepsinogens and their relationship to Helicobacter pylori infection and histological gastritis in dialysis patients.Nephrol Dial Transplant. 1999; 14: 2669-2675Crossref PubMed Scopus (21) Google Scholar, 40.Misra V. Misra S.P. Dwivedi M. et al.Decreased sensitivity of the ultrarapid urease test for diagnosing Helicobacter pylori in patients with chronic renal failure.Pathology. 1999; 31: 44-46Crossref PubMed Scopus (11) Google Scholar, 41.Yildiz A. Besisik F. Akkaya V. et al.Helicobacter pylori antibodies in hemodialysis patients and renal transplant recipients.Clin Transplant. 1999; 13: 13-16Crossref PubMed Scopus (27) Google Scholar, 42.Gur G. Boyacioglu S. Gul C. et al.Impact of Helicobacter pylori infection on serum gastrin in haemodialysis patients.Nephrol Dial Transplant. 1999; 14: 2688-2691Crossref PubMed Scopus (34) Google Scholar, 43.Huang J.J. Huang C.J. Ruaan M.K. et al.Diagnostic efficacy of (13)C-urea breath test for Helicobacter pylori infection in hemodialysis patients.Am J Kidney Dis. 2000; 36: 124-129Abstract Full Text Full Text PDF PubMed Scopus (29) Google Scholar, 44.Emir S. Bereket G. Boyacioglu S. et al.Gastroduodenal lesions and Helicobacter pylori in children with end-stage renal disease.Pediatr Nephrol. 2000; 14: 837-840Crossref PubMed Scopus (16) Google Scholar, 45.Aguilera A. Codoceo R. Bajo M.A. et al.Helicobacter pylori infection: a new cause of anorexia in peritoneal dialysis patients.Perit Dial Int. 2001; 21: S152-S156PubMed Google Scholar, 46.Schoonjans R. Van V.B. Vandamme W. et al.Dyspepsia and gastroparesis in chronic renal failure: the role of Helicobacter pylori.Clin Nephrol. 2002; 57: 201-207Crossref PubMed Scopus (44) Google Scholar, 47.Fabbian F. Catalano C. Bordin V. et al.Esophagogastroduodenoscopy in chronic hemodialysis patients: 2-year clinical experience in a renal unit.Clin Nephrol. 2002; 58: 54-59Crossref PubMed Google Scholar, 48.Tsukada K. Miyazaki T. Katoh H. et al.Seven-day triple therapy with omeprazole, amoxycillin and clarithromycin for Helicobacter pylori infection in haemodialysis patients.Scand J Gastroenterol. 2002; 37: 1265-1268Crossref PubMed Scopus (16) Google Scholar, 49.Nakajima F. Sakaguchi M. Amemoto K. et al.Helicobacter pylori in patients receiving long-term dialysis.Am J Nephrol. 2002; 22: 468-472Crossref PubMed Scopus (39) Google Scholar, 50.Marsenic O. Peco-Antic A. Perisic V. et al.Upper gastrointestinal lesions in children on chronic haemodialysis.Nephrol Dial Transplant. 2003; 18: 2687-2688Crossref PubMed Scopus (6) Google Scholar, 51.Strid H. Simren M. Stotzer P.O. et al.Delay in gastric emptying in patients with chronic renal failure.Scand J Gastroenterol. 2004; 39: 516-520Crossref PubMed Scopus (60) Google Scholar, 52.Lopez T. Quesada M. Almirall J. et al.Usefulness of non-invasive tests for diagnosing Helicobacter pylori infection in patients undergoing dialysis for chronic renal failure.Helicobacter. 2004; 9: 674-680Crossref PubMed Scopus (22) Google Scholar, 53.Nakajima F. Sakaguchi M. Oka H. et al.Prevalence of Helicobacter pylori antibodies in long-term dialysis patients.Nephrology (Carlton). 2004; 9: 73-76Crossref PubMed Scopus (23) Google Scholar, 54.Al-Mueilo S.H. Gastroduodenal lesions and Helicobacter pylori infection in hemodialysis patients.Saudi Med J. 2004; 25: 1010-1014PubMed Google Scholar, 55.Trimarchi H. Forrester M. Schropp J. et al.Low initial vitamin B12 levels in Helicobacter pylori—positive patients on chronic hemodialysis.Nephron Clin Pract. 2004; 96: c28-c32Crossref PubMed Scopus (17) Google Scholar, 56.Blusiewicz K. Rydzewska G. Rydzewski A. Gastric juice ammonia and urea concentrations and their relation to gastric mucosa injury in patients maintained on chronic hemodialysis.Rocz Akad Med Bialymst. 2005; 50: 188-192PubMed Google Scholar, 57.Lui S.L. Wong W.M. Ng S.Y. et al.Seroprevalence of Helicobacter pylori in Chinese patients on continuous ambulatory peritoneal dialysis.Nephrology (Carlton). 2005; 10: 21-24Crossref PubMed Scopus (7) Google Scholar, 58.Lentine K.L. Parsonnet J. Taylor I. et al.Associations of serologic markers of infection and inflammation with vascular disease events and mortality in American dialysis patients.Clin Exp Nephrol. 2006; 10: 55-62Crossref PubMed Scopus (16) Google Scholar, 59.Altay M. Turgut F. Akay H. et al.Dyspepsia in Turkish patients on continuous ambulatory peritoneal dialysis.Int Urol Nephrol. 2008; 40: 211-217Crossref PubMed Scopus (4) Google Scholar their results are still controversial, probably due to small number of studies and short duration periods. Only four previous studies examined more than 200 patients (maximum of 322 patients20.Wee A. Kang J.Y. Ho M.S. et al.Gastroduodenal mucosa in uraemia: endoscopic and histological correlation and prevalence of helicobacter-like organisms.Gut. 1990; 31: 1093-1096Crossref PubMed Scopus (51) Google Scholar), and no previous studies examined patients with mean dialysis duration periods of >100 months. In addition, only few reports evaluated the relationship between H. pylori infection and dialysis treatment duration.41.Yildiz A. Besisik F. Akkaya V. et al.Helicobacter pylori antibodies in hemodialysis patients and renal transplant recipients.Clin Transplant. 1999; 13: 13-16Crossref PubMed Scopus (27) Google Scholar, 49.Nakajima F. Sakaguchi M. Amemoto K. et al.Helicobacter pylori in patients receiving long-term dialysis.Am J Nephrol. 2002; 22: 468-472Crossref PubMed Scopus (39) Google Scholar Therefore, we aimed to clarify the prevalence of H. pylori infection in more than 500 patients receiving dialysis with a mean duration period of more than 8 years. Moreover, we first performed a follow-up survey to assess H. pylori infection in the same patient cohort receiving dialysis for 4 years. A total of 539 patients receiving dialysis at Tojinkai Hospital, Kyoto, Japan during April 1997 were enrolled in this study. A total of 400 patients with normal renal function who underwent endoscopy at the University Hospital of Kyoto Prefectural University of Medicine, Kyoto, Japan between January 1996 and April 1997 were also enrolled in this study. Among them 121 patients visited the hospital for annual health check irrespective of gastrointestinal symptoms and remaining patients for investigation of gastrointestinal symptoms. All patients were determined H. pylori status by serological test using anti-H. pylori immunoglobulin G (IgG) antibody at the beginning of this study in 1997. The detection of H. pylori status by anti-H. pylori IgG antibody in patients receiving dialysis treatment might be influenced by the impaired immune system, and might be judged as false-negative cases. To check the accuracy of this serological test, we performed 13C-urea breath test as well as two invasive tests using biopsy specimens obtained during endoscopy (H. pylori culture and rapid urease test) for randomly selected 70 patients who had either positive or negative serological test. When at least one of alternative tests yielded positive results, we judged the patients as H. pylori positive and compared with the serological test. The specificity, sensitivity, positive predictive value, negative predictive value, and accuracy of serological test were 94.1, 97.2, 97.0, 94.6, and 95.7%, respectively, confirming that this serological test was reliable and accurate even for patients receiving dialysis treatment. Demographic and clinical characteristics of patients enrolled at the beginning of the study (1997) are summarized in Table 1. The basement diseases in chronic dialysis patients were chronic glomerulonephritis (CGN) including IgA nephropathy, membranous nephropathy, minimal change, and antineutrophil cytoplasmic antibody-related nephritis (n=388), diabetes (n=103), and others including lupus nephritis, polycystic kidney, chronic pyelonephritis, and nephrosclerosis (n=48). There were no significant differences in age, sex, and symptom scores among different basement diseases of dialysis (Table 1). Gastrointestinal symptoms also had no association with H. pylori status and dialysis duration (data not shown). The prevalence of H. pylori infection and H. pylori IgG levels in patients with diabetic nephropathy was significantly higher than in the CGN group (P=0.01 for each) (Table 1). In addition, the treatment period in patients with diabetic nephropathy was 4.9±0.4 years, which was significantly shorter than those with the CGN group (9.2±0.4 years, P<0.01).Table 1Patient demographicsPatients with normal renal functionDialysis patientsAnnual health checkTotalCGNDiabetic nephritisOthersTotalP-value*Analyzed differences among three different basement diseases of hemodialysisP-value**Analyzed differences among dialysis patients and patients with normal renal functionn12140038810348539Sex (M/F)59/62223/117219/16955/4823/25296/2410.500.84Age56.6±0.858.4±0.658.7±0.660.4±1.359.4±1.958.8±0.40.490.45H. pylori+ (%)84 (69.4)314 (78.5)179 (46.1)62 (60.2)21 (43.8)262 (48.6)0.03<0.01H. pylori IgG (U/ml)22.3 (4.5–33.9)26.4 (20.1–38.3)8.7 (2.4–26.0)20.2 (2.6–24.8)8.9 (1.7–22.0)15.1 (2.3–25.0)0.19<0.01Dialysis period (year)NANA9.2±0.44.9±0.49.2±1.18.4±0.3<0.01—Symptom scores (%)NTNT1 (1–1)1 (1–1)1 (1–1)1 (1–1)0.33—1.4±0.7 (13.5)1.4±0.1 (15.2)1.1±0.1 (5.4)1.4±0.1 (13.0)CGN, chronic glomerulonephritis, NA, not available, NT, not tested.Age and dialysis period are reported as mean±SD, and H. pylori IgG levels and symptom scores are presented as median (25–75% quartiles), mean±SD and percentage of patients with symptom. Patients with normal renal function did not test the symptom scoring, but only presence/absence of symptom.* Analyzed differences among three different basement diseases of hemodialysis** Analyzed differences among dialysis patients and patients with normal renal function Open table in a new tab CGN, chronic glomerulonephritis, NA, not available, NT, not tested. Age and dialysis period are reported as mean±SD, and H. pylori IgG levels and symptom scores are presented as median (25–75% quartiles), mean±SD and percentage of patients with symptom. Patients with normal renal function did not test the symptom scoring, but only presence/absence of symptom. The prevalence of H. pylori infection in patients receiving dialysis (mean duration of 8.4±0.3 years) was 48.6% (95% confidence interval (CI): 44.3–52.9%, 262 of 539), which was significantly lower than in all patients with normal renal function (78.5%, 95% CI: 74.1–82.4%, 314 of 400, P<0.001) as well as patients with normal renal function who visited the hospital for annual health check (69.4%, 95% CI: 60.4–77.5%, 84 of 121, P=0.001) (Table 1). Importantly, the prevalence of H. pylori infection in patients receiving dialysis treatment for less than 1 year (74.1%, 60.3–85.0%, 40 of 54) was similar to annual health check patients with normal renal function (P=0.10). The mean duration of dialysis treatment in H. pylori-positive patients (6.62±0.4 years) was significantly shorter than in negative patients (9.45±0.4 years, P<0.01). Endoscopic examination was performed in 299 patients receiving dialysis treatment as well as all patients with normal renal function. There were no significant differences in age, sex, dialysis period, and H. pylori status between dialysis patients with and without receiving endoscopy (data not shown). Endoscopic findings were divided into five diseases: simple gastritis or normal appearing mucosa without ulcer and malignancy (gastritis), gastric ulcer, duodenal ulcer, gastric cancer, and others (Table 2). Endoscopic examination of dialysis patients revealed gastritis in 233 patients (77.8%), gastric ulcer in 34 (11.4%), duodenal ulcer in 19 (6.4%), and gastric cancer in 5 (1.7%) patients (Table 2). In patients with normal renal function, only 46.8% (187 of 400) had gastritis (P<0.01) probably due to the fact that patients with normal renal function were selected from patients who received endoscopy in the University Hospital where the frequency of patients visiting the hospital only for annual health check without symptoms was low. In fact, patients with normal renal function for annual health check revealed gastritis in 112 patients (92.6%), gastric ulcer in 5 (4.1%), and duodenal ulcer in 4 (3.3%) patients. As dialysis patients were not selected by the presence of gastrointestinal symptoms, we compared data of dialysis patients with those of only 121 patients with normal renal function for annual health check in subsequent analyses.Table 2Endoscopic findings in dialysis patients and patients with normal renal functionPatients with normal renal functionDialysis patientsDiseasesAnnual health checkTotalCGNDiabetic nephritisOthersTotaln1214002045837299Gastritis112 (92.6%)*P<0.05 (compared the prevalence with total of dialysis patients).187 (46.8%)*P<0.05 (compared the prevalence with total of dialysis patients).154 (75.5%)49 (84.5%)30 (81.1%)233 (77.8%)Gastric ulcer5 (4.1%)116 (29.0%)24 (11.7%)6 (10.3%)4 (10.8%)34 (11.4%)Duodenal ulcer4 (3.3%)72 (18.0%)15 (7.4%)1 (1.7%)3 (8.1%)19 (6.4%)Gastric cancer0 (0.0%)18 (4.5%)3 (1.5%)2 (3.4%)0 (0.0%)5 (1.7%)Others0 (0.0%)7 (2.5%)8 (3.9%)0 (0.0%)0 (0.0%)8 (2.7%)CGN, chronic glomerulonephritis.Others included patients with mucosa-associated lymphoid tissue lymphoma, submucosal tumor, and post-gastrectomy.* P<0.05 (compared the prevalence with total of dialysis patients). Open table in a new tab CGN, chronic glomerulonephritis. Others included patients with mucosa-associated lymphoid tissue lymphoma, submucosal tumor, and post-gastrectomy. Importantly, the prevalence of H. pylori infection was significantly lower in dialysis patients than in patients with normal renal function, irrespective of the clinical outcomes (Table 3). For example, among patients with gastritis alone, the prevalence of H.

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