Gastroduodenal mucosa in uraemia: endoscopic and histological correlation and prevalence of helicobacter-like organisms

Article Abstract:

When the kidneys fail to function properly, toxins that would normally be removed by these organs accumulate in the blood. This condition, known as uremia, must be treated either by transplanting a normally functioning kidney, or by dialysis (a technique in which blood is removed from the body, cleansed, and returned to the patient). It was thought that uremic patients undergoing dialysis and post-kidney-transplant patients were more prone to develop gastric and duodenal ulcer, but recent data have narrowed this tendency to the latter group only. Infection with the bacteria Helicobacter pylori has been implicated in the development of gastrointestinal diseases such as gastritis (inflammation of the stomach), as well as gastric and duodenal ulcer and inflammation. To investigate the presence of H. pylori infection in uremic patients undergoing dialysis and its connection with gastrointestinal disease, a study was performed with 422 patients undergoing maintenance dialysis as a result of permanent kidney failure. Of the 422 patients, 322 underwent endoscopy (viewing the interior of the stomach and intestine with a fiberoptic device), and duodenal biopsy (removal of small amounts of tissue for microscopic and biochemical analysis) was performed on 260 patients. Biopsy results indicated that 134 of the patients (52 percent) had gastritis and 52 (21 percent) had duodenal inflammation. For patients suffering from gastritis, there was no correlation between endoscopic and biopsy results, a finding that has been reported by others, but reasons for this remain unclear. A strong correlation between endoscopy and biopsy results was seen in patients with duodenal inflammation. H. pylori infection was seen in 81 patients (31 percent), and was associated largely with gastritis (acute rather than chronic), but not duodenal inflammation. Patients suffering from gastritis were significantly older than patients with other disorders, but they did not differ on other variables such as race, sex, or smoking status. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects, Identification and classification, Bacterial infections, Gastrointestinal diseases, Chronic kidney failure

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Age of onset of symptoms in duodenal and gastric ulcer

Article Abstract:

Gastric and duodenal ulcer are two related conditions in which the inner lining (mucosa) of the stomach or duodenum, respectively, develops a lesion or 'sore'. This painful condition (referred to generally as peptic ulcer) may have serious complications, and if not treated properly, can lead to fatal hemorrhage. Many specialists view ulcer, and duodenal ulcer (DU) in particular, as a heterogeneous disease in which several different underlying conditions may be reflected in the occurrence of these lesions. Patients in whom symptoms appear before the age of 30 differ from those with later onset in sex and race distribution, positive family history of ulcer, and incidence of gastrointestinal bleeding. In order to investigate whether this differential profile was present in residents of Singapore, and to compare gastric with duodenal ulcers, a study was carried out in a series of 492 patients (363 with DU, 98 with gastric ulcer, and 31 with combined gastric and duodenal ulcers). Patients with early-onset DU (before age 30) were more likely to be men than late-onset DU patients. Similarly, patients with early-onset DU were more likely to have a positive family history of hemorrhage than late-onset patients; this was also true for a positive family history for dyspepsia (painful or impaired digestion). Levels of gastric acid secretion were higher in early-onset DU patients. The age of onset of DU was different in two of the major racial groups of Singapore; Malay patients first developed symptoms at an average age of 43 years, while the average age in Chinese patients was 33 years. In patients suffering from gastric ulcer the same sort of differential distribution by sex was noted, but early- and late-onset patients were evenly matched on the other variables. (Consumer Summary produced by Reliance Medical Information, Inc.)

Duodenal ulcer

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Helicobacter pylori and gastritis in patients with peptic ulcer and non-ulcer dyspepsia: ethnic differences in Singapore

Article Abstract:

Dyspepsia, or discomfort associated with the ingestion and digestion of food, can have a variety of causes. Among them is gastritis, an inflammatory condition of the stomach, which may or may not be associated with the presence of peptic ulcer (ulcer of the stomach or intestine). Presence of the bacteria Helicobacter pylori has been linked to ulcers, gastritis, and dyspepsia, but the exact role this microorganism plays is not clear. Residents of Singapore are of three major races: Chinese, Malay, and Indian, and each race has a different rate of peptic ulcer. In order to determine the prevalence of Helicobacter pylori infection in these three races, and to ascertain the relationship between Helicobacter infection and gastrointestinal function, a study was carried out involving the removal of biopsy specimens (small pieces of tissue) from the gastrointestinal tracts of 1,502 undergoing endoscopic ex examination of the stomach and duodenum. Fifty-nine percent of the biopsy specimens tested positive for infection with Helicobacter pylori. Seventy-three percent of the subjects with gastritis were H. pylori positive compared with only 6 percent of the subjects without gastritis. The rates of both bacterial infection and gastritis were similar among members of all three races. Patients with peptic ulcer were more likely to be infected with Helicobacter pylori than those who had dyspepsia resulting from a condition other than ulcer. These results do not explain the racial differences in peptic ulcer frequency, but suggest that the pathophysiology of non-ulcer dyspepsia may be different in the different races of Singapore. (Consumer Summary produced by Reliance Medical Information, Inc.)

Causes of, Indigestion

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