Peptic ulcer and gastritis in uraemia, with particular reference to the effect of Helicobacter pylori infection

Aims: To determine: (i) the prevalence of histological gastritis and peptic ulcer; and (ii) the clinical features of peptic ulcer, in patients with en d-stage renal failure. Methods: Upper endoscopy was performed by a single observer in 268 patients with end-stage renal failure over a 6-year period. Gastric histology and H elicobacter pylori status were studied in 40 consecutive subjects in whom t here were no contraindications for gastric biopsy and who had not used anti bacterial drugs in the preceding 4 weeks. As there are only limited data fo r healthy volunteers in Singapore, 33 age-, sex- and race-matched patients with functional dyspepsia from an earlier drug trial and 18 healthy volunte ers who were not age-matched were used as controls. The clinical features o f 43 consecutive uraemic patients with peptic ulcer were compared with thos e of 118 consecutive non-uraemic peptic ulcer patients seen by the same aut hor. Results: Among uraemic patients, histological gastritis was less common, co mpared with healthy volunteers and functional dyspepsia patients. Helicobac ter pylori infection as assessed by histology was also less common among ur aemic patients compared with functional dyspepsia patients, but the differe nce was not statistically significant on serological assessment. Uraemic pa tients with ulcer had an equal sex ratio, in contrast to a male preponderan ce among peptic ulcer patients with normal renal function. Uraemic patients with ulcer were more likely to be pain-free, to present with haemorrhage, to have multiple ulcers and postbulbar duodenal ulcers, but were less likel y to have H. pylori infection. Among uraemic subjects, the prevalence of H. pylori infection was similar whether or not peptic ulcer was present. Conclusions: The prevalence of histological gastritis was lower in uraemic patients when compared with patients with functional dyspepsia and healthy volunteers. Peptic ulcers in uraemic subjects have different clinical chara cteristics from peptic ulcer in non-uraemic subjects. (C) 1999 Blackwell Sc ience Asia Pty Ltd.