Gastroduodenal lesions in peritoneal dialysis patients: the role of Helicobacter pylori infection

The aim of this study was to examine the prevalence of Helicobacter pylori infection and the associated gastroduodenal lesions in peritoneal dialysis patients. Ninety-eight patients with dyspeptic complaints were included in the study. They were divided into two groups; group 1 consisted of 48 patients with endstage renal disease (ESRD) on PD and group 2 (control) of 50 patients without renal disease. All patients were subjected to upper gastrointestinal endoscopies, and gastric biopsies were obtained for histological evidence of H.pylori infection. Anti-H.pylori IgG antibodies were tested in the PD patients using the ELISA test. The mean age of both groups was similar. Twenty-three (47.9%) of the 48 patients on PD and 25 (50.0 %) of the 50 nonrenal disease patients were positive for H.pylori infection. There was no significant difference in H.pylori prevalence between the two groups (P>0.05). No correlation was found between H.pylori infection and age, sex, primary disease, or type (CAPD or APD). However, prevalence was significantly higher (30.4% vs 17.4%, P<0.001) in patients who were on PD for less than 24 months. False positive serology for H.pylori in the absence of positive histology was found in 7 out of the 25 negative cases (28.0 %) in the dialysis group. The prevalence of duodenal ulcers was significantly higher in H.pylori positive than in H.pylori negative ESRD patients on PD (18.8% vs 8.3%, P<0.05). Gastroesophageal reflux disease (GERD) was seen in 21 (43.8%) patients in group 1 and in 8 (16%) cases in group 2 (P<0.01). GERD was, however, significantly lower in H.pylori positive patients in both groups (12.5% vs 31.3% in group 1 and 4% vs 12% in group 2, P<0.001 and P<0.01, respectively). In conclusion, long-term PD seems to decrease the prevalence of H.pylori infection. Testing H.pylori antibodies lacks specificity for diagnosing active H.pylori infection in PD patients. H.pylori infection in patients on PD is associated with increased risk of gastroduodenal lesions and decreased prevalence of GERD.