Abstract
The aim of this work was to assess gastric acid secretion in relation to morphological and histological changes in the gastric mucosa as well as prevalence ofHelicobacter pylori in chronically haemodialyzed uraemic patients. Exocrine pancreatic functions after secretin-cerulein test were also studied. In haemodialyzed patients low basal gastric acid output was found, whereas peak output after pentagastrin stimulation did not differ significantly when compared to controls. Endoscopy of gastric and duodenal mucosa revealed inflammatory changes in the majority of patients, described histologically as chronic gastritis with duodenitis.Helicobacter pylori antigen was detected in the serum of 45% of uraemic patients. Serum amylase activity was elevated in haemodialyzed patients relative to controls. Although clinically asymptomatic, haemodialyzed patients exhibited various degrees of gastrointestinal mucosal abnormalities and impairment in exocrine pancreatic functions, mainly low stimulated bicarbonate and protein output as well as low electrolyte concentrations in duodenal content.
Similar content being viewed by others
References
Wee, A., Kang, J. Y., Ho, M. S., Choong, H. L., Wu, A. Y. T., Sutherland, I. H.: Gastroduodenal mucosa in uraemia: Endoscopic and histological correlation and the prevalence of Helicobacter-like organisms.Gut, 31, 1093 (1990).
Mason, E. E.: Gastrointestinal lesions occuring in uraemia.Ann. Intern. Med., 37, 96 (1952).
Bartos, V., Melichar, J., Erben, J.: The function of exocrine pancreas in chronic renal disease.Digestion, 3, 33 (1970).
Keogh, J. B., McGeeney, K. F., Drury, M. I., Counihan, T. B., O'Donnel, M. D.: Renal clearance of pancreatic and salivary amylase relative to creatinine in patients with chronic renal insufficiency.Gut, 19, 1125 (1978).
Otte, M., Stahlheber, H., Forell, M. M., Dobbelstein, H., Richert, J., Thurmayer, R., Thurmayer, G. R.: Exokrine Pankreasfunktion bei chronischer Nierenisuffizienz.Klin. Wochenschr., 53, 67 (1975).
Avram, M. M., Iancu, M.: Pancreatic disease in uremia and parathyroid hormone excess.Nephron, 32, 60 (1982).
Vaziri, N. D., Dure-Smith, B., Miller, R., Mirahmadi, M.: Pancreatic pathology in chronic dialysis patients—An autopsy study of 78 cases.Nephron, 46, 347 (1987).
Abu-Alfa, A., Ivanovich, P., Mujais, S. K.: Uremic exocrine pancreatopathy.Nephron, 46, 94 (1988).
Baggenstoss, A. H.: The pancreas in uremia: A histopathologic study.Am. J. Pathol., 24, 1003 (1948).
El Ghonaimy, E., Barsoum, R., Soliman, M., El Fikky, A., Rashwan, S., El Rouby, O., Hadolad, S., El Khashab, O., Abou Zeid, M., Hassaballah, N., Hassaballah, A.: Serum gastrin in chronic renal failure: Morphological and physiological correlations.Nephron., 39, 86 (1985).
Muto, S., Murayama, N., Asano, Y., Hosoda, S., Miyata, M.: Hypergastrinemia and achlorhydria in chronic renal failure.Nephron, 40, 143 (1985).
Gold, C. H., Morley, J. E., Hljoen, M., OuTim, L., de Fomseca, M., Kalk, W. J.: Gastric acid secretion and serum gastrin levels in patients with chronic renal failure on regular hemodialysis.Nephron, 225, 92 (1980).
Royse, V. L., Jensen, D. M., Corwin, H. L.: Pancreatic enzymes in chronic renal failure.Arch. Intern. Med., 147, 537 (1987).
Vaziri, N. D., Chang, D., Malekpoier, A., Radaht, S.: Pancreatic enzymes in patients with end-stage renal disease maintained on hemodialysis.Am. J. Gastroenterol., 83, 410 (1988).
Vaziri, N. D., Dure-Smith, B., Miller, R., Mirahmadi, M. K.: Pathology of gastrointestinal tract in chronic hemodialysis patients; an autopsy study of 78 cases.Am. J. Gastroenterol., 80, 608 (1985).
Milito, G., Taccone-Gallucci, M., Brunaleone, C., Naroli, F., Cesca, D., Boffo, V., Casciani, C. U.: The gastrointestinal tract in uremic patients on longterm hemodialysis.Kidney Int., 28 (Suppl. 17), S157 (1985).
Whitehead, R., Truelove, S. G., Gear, M. W. L.: The histological diagnosis of chronic gastritis in fiberoptic gastroscope biopsy specimens.J. Clin. Pathol., 25, 1 (1972).
Whitehead, R., Roca, M., Meikle, D. D., Skinner, J. M., Truelove, S. G.: The histological classification of duodenitis in fiberoptic biopsy specimens.Digestion, 13, 129 (1975).
Paimela, H., Stenman, S., Kekki, M., Sipponen, P., Tallgren, L. G., Scheinin, T. M.: Chronic gastritis and gastric secretion in uraemic and renal transplant patients.Hepatogastroenterol., 32, 15 (1985).
Doherty, C. C., Mc Geown, M. G.: Peptic ulceration, gastric acid secretion and kidney transplantation.Dial. Transplant., 8, 970 (1979).
Garg, A. K., Gulati, P. D., Misra, R. C., Saha, M. M., Rizvi, S. N. A., Chauhan, L. C.: Gastric functions in chronic uremia and effects of dialysis.Indian. J. Gastroenterol., 3, 73 (1984).
Gordon, E. M., Johnson, A. G., Williams, G.: Gastric assessment of preoperative renal transplant patients.Lancet, i, 226 (1972).
Taylor, I. L., Sells, R. A., Mc Connell, R. B., Dockray, G. J.: Serum gastrin in patients with chronic renal failure.Gut, 21, 1062 (1980).
Sullivan, S. N., Tustanoff, E., Slaughter, D. N.: Hypergastrinemia and gastric acid hypersecretion in uremia.Clin. Nephrol., 5, 25 (1976).
Korman, M. G., Laver, M. C., Hansky, J.: Hypergastrinemia in chronic renal failure.Br. Med. J., 1, 209 (1972).
Ven Kateswaran, P. S., Jeffers, A., Hocken, A. G.: Gastric acid secretion in chronic renal failure.Br. Med. J., 4, 22 (1972).
Doherty, C. C.: Gastric secretion in chronic uremia and after renal transplantation.Ir. J. Med. Sci., 149, 5 (1980).
Ala-Kaila, K., Kataja, M., Keyriläinen, O., Pasternack, A.: The gastrin secretion profile of patients with chronic renal failure.Ann. Clin. Res., 13, 65 (1981).
Lieber, C. S., Lefevre, A.: Ammonia as a source of gastric hypoacidity in patients with uremia.J. Clin. Invest., 38, 1271 (1959).
Grace, S. G., Davidson, W. D., State, D.: Renal mechanisms for removal of gastrin from circulation.Surg. Forum., 25, 323 (1974).
Kang, J. Y., Wu, A. Y. T., Sutherland, I. H., Vathsala, A.: Prevalence of peptic ulcer in patients undergoing maintenance hemodialysis.Dig. Dis. Sci., 33, 774 (1988).
Margolis, D. M., Saylor, J. L., Geisse, D., De Schryrer-Kecskemeti, K., Harter, H. R., Zuckerman, G. R.: Upper gastrointestinal disease in chronic renal failure.Arch. Intern. Med., 138, 1214, (1978).
Mitchell, C. J., Jewel, D. P., Lewin, M. R., Mc Laughlin, J. E., Moorhead, J. F.: Gastric function and histology in chronic renal failure.J. Clin. Pathol., 322, 208 (1979).
Rovelstad, R. A.: The incompetent pyloric sphincter. Bile and mucosal ulceration.Am. J. Dis., 21, 165 (1976).
Mc Connell, J. B., Stewart, W. B., Thjodleifsson, B., Wormsley, K. G.: Gastric function in chronic renal failure. Effects of maintenance hemodialysis.Lancet, ii, 1121 (1975).
Murakami, M., Yoo, J. K., Mijuno, M., Saita, K., Inada, M., Miyake, T.: Role of gastric ammonia urea, and urease in gastric mucosal lesions in azotemia.Gastroenterology, 92, 1545A (1987).
Kim, H., Park, C., Jang, W. I.: The gastric juice urea and ammonia levels in patients with Campylobacter pylori.Am. J. Clin. Pathol., 94, 187 (1990).
Gladziwa, U., Haase, G., Handt, S., Riehl, J., Wiethdtz, H., Dakshimamurty, K. V., Glöckner, W. M., Sieberth, H. G.: Prevalence of Helicobacter pylori in patients with chronic renal failure.Nephrol. Dial. Transplant., 8, 301 (1993).
Shousha, S., Arnauta, A. H., Abbas, S. H., Parkins, R. A.: Antral Helicobacter pylori in patients with chronic renal failure.J. Clin. Pathol., 43, 397 (1990).
Triebling, A. T., Korsten, M. A., Dlugosz, J. W., Paronetto, F., Lieber, I. S.: Severity of Helicobacter-induced gastric injury correlates with gastric juice ammonia.Dig. Dis. Sci., 36, 1089 (1991).
Noda, A.: Renal handling of amylase: Evidence for reabsorption by stop-flow analysis.Metabolism, 21, 351 (1972).
Pasternack, A., Klockars, M.: Clearance ratios of amylase and isoamylase to creatinine in renal disease.Clin. Nephrol., 9, 25 (1978).
Farnzin, G., Musola, R., Mencarelli, R.: Morphological changes of the gastroduodenal mucosa in regular dialysis uraemic patients.Histopathology, 6, 429 (1982).
Poll, W. M., Werner, J., Huber, W., Kempmann, G., Willing, F.: Exokrine Pankreasfunktion bei chronischer Niereninsuffizienz.Z. Gastroent., 17, 177 (1979).
Moses, R., Panebianco, P., Dinoso, V. P., Chey, W. Y., Kostman, J. R., Clearfield, H. R., Murthy, S. N. S.: Decreased pancreatic bicarbonate responsiveness to graded doses of secretin in end-stage renal disease (Abstract).Gastroenterology, 86, 1190 (1984).
Wittich, K. A., Schmidt, H., Scheler, F., Creutzfeldt, W.: Exokrine Pankreasfunktion bei chronischer Niereninsuffizienz.Verh. dt. Ges. Inn. Med., 74, 1072 (1968).
Sachs, E. F., Hurwitz, F. J., Bloch, H. M., Milne, F. J.: Pancreatic exocrine hypofunction in the wasting syndrome of end-stage renal disease.Am. J. Gastroenterol., 78, 170 (1983).
Owyang, C., Miller, L. J., Di Magno, E. P., Mitchell, J. C., Go, V. L. W.: Pancreas exocrine function in severe, human chronic renal failure.Gut, 23, 357 (1982).
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Malyszko, J., Sosnowski, S., Mazerska, M. et al. Gastric and pancreatic functions in haemodialyzed patients. International Urology and Nephrology 27, 471–478 (1995). https://doi.org/10.1007/BF02550086
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF02550086