ABSTRACT
Objective: We aimed to evaluate dyspeptic hemodialysed patients regarding upper endoscopy findings and HP status. Also to determine the accuracy of several tests, including culture, histology, rapid urease test, serology and Hp stool antigen to screen for H. pylori infection in dyspeptic hemodialysed patients and evaluate the success of eradication therapy in patients with ESRD
Patients and methods: 44 patients with ESRD on regular hemodialysis and 40 dyspeptic patients with normal renal function as a control group were included in the study. All patients underwent upper endoscopy with biopsy intake for HP histopathology, culture and rapid urease test [RUT]. HP positive result was based on histopathology and or culture. HpSA, and Hp-lgG were also performed. HP infected patients were scheduled to undergo 7-day triple therapy and the success of eradication therapy was investigated
Results: 20 of ESRD patients [54.5%] and 25 patients of control group [62.5%] were proven to be infected with HP. The endoscopy findings of the gastroduodenal mucosa in dialysis patients were similar to that of controls, as was the incidence of peptic ulcers. Dialysis patients had a significantly lower prevalence of H. pylori infection than control subjects. In the histological study. H. pylori-positive patients had significantly higher inflammation and activity scores than H. pylori-negative patients for both dialysis patients and controls. The culture technique provided sensitivity, specificity, PPV and NPV of 54.9, 100, 100 and 70.6%, respectively. The CLO test provided sensitivity, specificity, PPV and NPV of 98, 90.0, 92.1 and 98.9%, respectively. The histology provided sensitivity, specificity, PPV and NPV of 93.4, 90.6, 90.5 and 94.0 %, respectively. The serological test of IgG antibodies yielded sensitivity, specificity, PPV and NPV of 96.0, 64.0, 78.6 and 95.9%, respectively. For the detection of HPSA using FemtoLAB yielded sensitivity, specificity, PPV and NPV of 86.0 100, 100, and 91.0%, respectively, using Premier Platinum yielded sensitivity, specificity, PPV and NPV of 58.0, 86.0 92.0 and 53.0%, respectively, simple rapid test yielded sensitivity. specificity. PPV and NPV of 61.0% 78%, 74.0% and 67% respectively
Conclusion: Upper GI abnormalities are common among HD patients. Biopsy proven antral gastritis is the most common histological diagnosis among these patients and is highly associated with H. pylori infection. Prevalence of H.pylori infection in HD patients is similar to those with normal renal function undergoing endoscopy for dyspepsia. FemtoLAB HpSA is a noninvasive reliable. inexpensive, and reproducible test for diagnosis and follow up of eradication of HP infection in ESRD patients on regular hemodialysis. Detection and treatment of HP improved dyspeptic symptoms in ESRD patients on hemodialysis