HELICOBACTER-PYLORI AND UREMIC GASTRITIS - A HISTOPATHOLOGIC STUDY AND A CORRELATION WITH ENDOSCOPIC AND BACTERIOLOGICAL FINDINGS

In this work 70 asymptomatic uremic patients under maintenance hemodia lysis in our institution underwent upper-gastrointestinal endoscopy as part of a routine investigation prior to kidney transplantation. Thei r endoscopic findings were scored and antral mucosal biopsies were obt ained and subjected to histopathologic and bacteriologic assessment. B acteriologic examination included culture, rapid urease test, and micr oscopic examination for detection of Helicobacter pylori. Histopatholo gic examination of the gastric mucosa showed chronic superficial gastr itis in 52%, atrophic gastritis in 5.7% and intestinal metaplasia in 3 7% of the cases. Of the cases with superficial gastritis, 5 showed in addition gastric mucosal dysplastic changes. There was no correlation between the histopathologic and endoscopic findings. Nevertheless, the re was a significant association between histopathologic changes and H . pylori infection (p = 0.0001). All cases with atrophic gastritis sho wed H. pylori, and of 24 cases with chronic active superficial gastrit is. H. pylori was detected in 18, while it was detected in only 2 of 1 3 cases with chronic inactive superficial gastritis and in 4 of 29 cas es with normal antral mucosal biopsies. Among different variables in d ialysis patients, only patients' ages were found to have significant a ssociation with H. pylori infection (p < 0.03). We have concluded that in asymptomatic uremic patients under maintenance hemodialysis, relyi ng only on endoscopy for critical assessment of the upper gastrointest inal tract is unsatisfactory and histopathologic examination of the an tral mucosal biopsies is mandatory. Chronic superficial gastritis and atrophic gastritis should be expected in up to 60% of the patients, an d there is a strong association between H. pylori infection and gastri tis.