Changes in the Upper Gastrointestinal track in patterns with chronic renal failure

Abstract

Between February and July 1987, some 40 consecutive patients with established chronic renal failure, on either maintenance dialysis or conservative management, were studied to determine the nature and incidence of upper gastrointestinal tract mucosal disease. Serum assays for gastrin, bombesin and gastric inhibitory polypeptide were also done.

Endoscopic gastritis was evident in 27.5%, duodenitis in 20%, bile reflux in 17.5%, distorted duodenal bulb in 17.5% oesophangitis in 5% and duodenal ulcer in 5%. In 32.5% of the patients there was no endoscopic abnormality noted. No patient had active gastrointestinal bleeding. Gastrin and gastric inhibitory polypeptide were significantly elevated in all study cases when compared to the controls. None of the cases had conditions, other than chronic renal failure to account for fasting hypergastrinemia. Fasting serum gastrin levels did not correlate significantly with endoscopic diagnosis, serum creatinine or creatinine clearance. A statistically significant correlation was found between serum gastrin and bombesin levels.

The results indicate a high prevalance of inflammatory and hypertrophic mucosal changes in chronic renal failure but not peptic ulcer disease, and suggest that these changes may be a consequence of hypergastrinemia.

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It is r~ded that all chronic renal failure patients with significantupper gastrointestinal symptomatology and all pre­ renal transplant patients undergo upper gastrointestinal endoscopicassessement.