Lower gastrointestinal bleeding in patients with end stage renal disease in Assiut University Hospitals

ABSTRACT

To evaluate the association of lower gastrointestinal bleeding [LGIB] with patients of end stage renal disease [ESRD] maintained on regular hemodialysis, the present study was designed on a prospective basis, it was carried out on 60 patients of ESRD 36 males [60%], 24 females [40%] complaining of lower gastrointestinal bleeding in a different variety with a mean age +/- SD of 40 +/- 10 years and another 20 patients of ESRD with no gastrointestinal bleeding regarding occult blood in stools as a control group, all were diagnosed at the Nephrology Unit of Assiut University Hospitals through the year 2006. The Patients and control were divided into three groups- [A] 20 patients of ESRD [12 males and 8 females] having marked pallor, iron deficiency anemia with faecal occult blood positivity. [B] 20 patients of ESRD [11 males and 9 females] who have chronic intermittent hematochezia. [C] 20 patients of ESRD [13 males and 7 females] suffering acute severe hematochezia. [D] Another 20 patients of ESRD [11 males and 9 females] with no lower gastrointestinal bleeding as a control group. All patients in group A, B, C were subjected to upper and lower gastrointestinal endoscopy, groups A and controls were subjected to stool occult blood estimation using slide test [hema screen test]. The studied groups showed the following results: [1] 31 cases [51.7%] of ESRD patients with LGIB had angiodysplastic lesions of the colon, while the other 29 cases of [48.3%] had upper gastrointestinal lesions. [2] Upper gastrointestinal lesions may be massive enough to cause LGIB. [3] Quality and quantity of LGIB showed significant difference with duration of dialysis Patients presented with acute severe haematochezia showed duration of dialysis longer than those of moderate intermittent one and patients presented with positive faecal occult blood showed duration longer than the other two groups. The duration of dialysis in patients having angiodysplasia of the colon was significantly longer than control group. On the other hand, patients of control group had underwent duration of dialysis longer than group B and they did not show any gastrointestinal bleeding, this may mean that long duration of dialysis alone is not a definite cause of the bleeding. [4] 32 patients [53, 3%] of studied groups had inefficient dialysis, while 28 [46.7%] patients had efficient dialysis. The dialysis in 23 cases of 31 patients of ESRD with angiodysplasia was also inefficient dialysis, while the other 8 cases were on efficient dialysis. So, inefficient dialysis may contribute to the occurrence of LGIB, but it is not the only definitive cause for this bleeding. It could be concluded that [I] middle aged males were more liable to LGIB than middle I aged females; [2] Angiodysplasia of the colon was the most common cause of LGIB in our studied groups, but upper gastrointestinal tract lesions should also be considered. [3] Long term duration of dialysis may share in the occurrence of LGIB. [4] Inefficient dialysis may have a role in the occurrence of this bleeding. We can recommend that patients of ESRD presenting with severe microcytic hypochromic anemia should be examined for faecal occult blood aiming at early detection of angiodysplasia of the colon