Böbrek nakli alıcı adaylarında Helicobacter pyloriprevalansı ve endoskopik bulgularla ilişkisi

Giriş ve amaç: Helicobacter pylorienfeksiyonu peptik ülser, gastrik kanser ve gastrik MALT lenfoma ile yakın ilişkilendirilmiştir. Türkiye'de normal böbrek fonksiyonu olan hastalarda Helicobacter pyloriprevalansı yüksek olup Helicobacter pylorienfeksiyonu üst gastrointestinal sistem bulguları olan hastalarda majör risk faktörü olarak düşünülmektedir. Buna rağmen kronik böbrek yetmezlikli hastalarda Helicobacter pylori'ningastrointestinal mukozal lezyonlarla ilişkisi net olarak bilinmemektedir. Bu çalışmanın amacı böbrek nakli alıcı adaylarındaki endoskopik bulguları değerlendirmek, bu hastalardaki Helicobacter pyloriprevalansını saptamak ve endoskopik bulgularla Helicobacter pyloriprevalansı arasında ilişki olup olmadığını belirlemektir. Gereç ve Yöntem: Bu amaçla hastanemizde böbrek nakli yapılmış olan 64 hastanın nakilden hemen önceki hazırlık aşamasında yapılan endoskopik bulguları, endoskopik antrum biyopsilerinde hızlı üreaz testi ile saptanan Helicobacter pylorisıklığı analiz edilmiştir. Bulgular:Çalışmaya 64 hasta alınmıştır. Hastaların 41'i (%64) erkek ve 23'ü (%36) kadın hasta idi, hastaların yaş ortalaması 44.7±13.0 (18-67) olup, ortalama diyaliz süreleri 43,0±42,7 (6-189) ay idi, endoskopide 5 (%8) hastada gastrik veya duodenal ülser, 55 (%86) hastada gastrit, 1(%1.8) hastada özofajit, 8 (13%) hastada ise normal endoskopik bulgular izlenmiştir. Endoskopik antral biyopsilerde 9 (%14) hastada Helicobacter pyloripozitif, buna karşın 55 (%86) hastada Helicobacter pylorinegatif saptanmıştır. Endoskopik bulgular arasında sadece gastrik veya duodenal ülser varlığı Helicobacter pylori enfeksiyonu ile istatistiksel olarak anlamlı olarak ilişkilendirilmiş diğer endoskopik bulgular ise Helicobacter pylorienfeksiyonu olan ve olmayan hastalarda benzer oranlarda görülmüştür. Diyaliz tipi ve diyaliz sürelerinin Helicobacter pylorivarlığı ile ilişkisi bulunamamıştır. Sonuç: Böbrek nakli alıcı adaylarındaki Helicobacter pyloriprevalansı normal topluma göre belirgin oranda düşüktür. Helicobacter pylorienfeksiyonu endoskopide yalnızca peptik ülser varlığı ile yakın ilişkilendirilmiş olup peptik ülser dışı endoskopik bulgular Helicobacter pyloridışı faktörler ile ilişkilendirilebilinir.

Anahtar Kelimeler:

Helicobacter pylori, kronik böbrek yetmezliği, böbrek nakli

Helicobacter pyloriprevalence and its association with endoscopic findings in renal transplant candidates

Background and Aims: Helicobacter pyloriinfection is closely associated with the development of peptic ulcers, gastric cancer and gastric MALT lymphoma. Its prevalence is high in patients with normal renal function in Turkey and is thought to be one of the major risk factors for gastrointestinal symptoms. It is unclear however, whether Helicobacter pyloriinfection is directly associated with gastrointestinal mucosal lesions in patients with chronic renal failure. Materials and Methods:The aim of this study was to evaluate the endoscopic findings of renal transplant candidates and to assess the prevalence of Helicobacter pyloriinfection. We retrospectively analysed the data of 64 renal transplant candidates' endoscopies and antrum biopsy results for Helicobacter pyloriinfection. Results: Sixty-one patients were included in the study. Forty-one (64%) patients were male and 23 (36%) female; at the time of endoscopy mean patient age was 44.7±13.0 (range, 18-67); mean duration of dialysis was 43.0±42.7 (range, 6-189) months; 5 (8%) patients had gastric or duedenal ulcers; 55 (86%) patients had gastritis; 1(1.8%) patient had esophagitis; and 8 (13%) patients had normal endoscopic findings. Endoscopic antral biopsy revealed that 9 (14%) patients were Helicobacter pyloripositive, whereas 55 ( 86%) patients were Helicobacter pylorinegative. Among the endoscopic findings, only peptic ulcer was closely associated with Helicobacter pylori infection. There was no correlationn between dialysis type or duration and the presence of Helicobacter pyloriinfection. Conclusions:Renal transplant candidates have significantly lower Helicobacter pylori prevalence than the normal population. Helicobacter pyloriinfection is closely associated with the presence of peptic ulcers in renal transplant candidates. There are factors other than Helicobacter pyloriinfection associated with esophagogastroduedenal lesions in patients with chronic renal failure.

Keywords:

Helicobacter pylori, chronic renal failure, renal transplantation,

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Ozaydin ANG, Cali S, Türkyilmaz AS. Turkey Helicobacter pylori prevalence survey 2003. [In Turkish]. Marmara Saglik ve Egitim Arastirma Vakfi, İstanbul. 2007;42.
Khedmat H, Ahmadzad-Asl, M, Amini M, et al. Gastroduedenal le- sions and Helicobacter pylori infection in uremic patients and renal transplant recipients. Transplant Proc 2007; 39:1003-7.
Doherty CC. Gastrointestinal bleeding in dialysis patients. Nephron 1993;63:132-6.
Kang JH, Ho KY, Yeoh KG, et al. Peptic ulcer and gastritis in ure- mia, with particular reference to the effect of Helicobacter pylori infection. J. Gastroenterol Hepatol 1999;14:771-8.
Nakajima F, Sakaguchi M, Amemoto K, et al. Helicobacter pylori in patients receiving long-term dialysis. Am J Nephrol 2002;22:468- 72.
Khedmat H, Taheri S. Current knowlegde on Helicobacter pylori infection in end stage renal disease patients. Saudi J Kidney Dis Transpl 2009; 20:969-74.
Loffeld RJ, Peltenberg HG, vd Oever H, Stobberingh E. Prevalence of Helicobacter pylori antibodies in patients on chronic intermittent hemodialysis. Nephron 1991;59:250-3.
Fabrizi F, Martin P. Helicobacter pylori infection in patients with end-stage renal disease. Int J Artif Organs 2000;23:157-64.
Ozgür O, Boyacioglu S, Ozdogan M, et al. Helicobacter pylori in- fection in hemodialysis patients and renal transplant recipients. Nephrol Dial Transplant 1997;12:289-91.
Itatsu T, Miwa H, Nagahara A, et al. Eradication of Helicobacter pylori in hemodialysis patients. Renal Failure 2007;29:97-102.
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;37:1265-8.
Nakajima F, Sakaguchi M, Oka H, et al. Prevalence of Helico- bacter pylori antibodies in long term dialysis patients. Nephrology 2004;9:73-6.
Wang YL, Sheu BS, Huang JJ, Yang HB. Noninvasive stool antigen assay can effectively screen Helicobacter pylori infection and assess success of eradication therapy in hemodialysis patients. Am J Kid- ney 2001;38:98-103.
Malfertheiner P, Megraud F, O’Morain CA, et al. Management of Helicobacter pylori infection- the Maastricht IV /Florence Consen- sus Report. Gut 2012;61:646-64.
Gladziwa U, Haase G, Handt S, et al. Prevalence of Helicobacter pylori in patients with chronic renal failure. Nephrol Dial Transport 1993;8:301-6.
Sugimoto M, Sakai K, Kita M, Imanishi J, Yamaoka Y. Prevalence of Helicobacter pylori infection in long-term hemodialysis patients. Kidney International 2009,75:96-103.
Moriyama T, Matsumoto T, Hirakawa K, et al. Helicobacter pylori status and esophagogastroduedenal mucosal lesions in patients with end-stage renal failure on maintenance hemodialysis. J Gas- troenterol 2010,45:515-22.
Sezer S, Ibis BH, Ozdemir FN, et al. Association of Helicobacter pylori with nutritional status in hemodialysis patients. Transplant Proceedings 2004; 36:47-9.
Shousha S, Arnaout AH, Abbas SH, Parkins RA. Antral Helico- bacter pylori in patients with chronic renal failure. J Clin Pathol 1990;43:397-9.
Berstad A, Alexander B, Weberg R, et al. Antacids reduce Comply- bacter pylori colonization without healing the gastritis in patients with non-ulcer dyspepsia and erosive prepyloric changes. Gastroen- terology 1988;95:619-24.
Baradaran A, Nasri H. Helicobacter pylori spesific IgG antibody and serum magnesium in type-2 diabetes mellitus chronic kidnet dis- ease patients. Saudi J Kidney Dis Transpl 2011;22:282-5.
Sotoudehmanesh R, Ali Asgari A, Ansari R, Nouraie M. Endoscopic findings in end-stage renal disease. Endoscopy 2003;35:502-5.