Encapsulating peritoneal sclerosis: the state of affairs

Area of Science:

• Nephrology
• Gastroenterology
• Pathology

Background:

• Encapsulating peritoneal sclerosis (EPS) is a serious complication of long-term peritoneal dialysis (PD), associated with a 50% mortality rate.
• EPS involves progressive fibrotic thickening of the peritoneum, leading to bowel encapsulation and intestinal obstruction.
• Early detection of EPS is challenging, though a decline in ultrafiltration capacity often precedes its onset.

Purpose of the Study:

• To review the current understanding of Encapsulating Peritoneal Sclerosis (EPS) pathogenesis, risk factors, and diagnostic challenges.
• To highlight the role of peritoneal dialysis (PD) fluid exposure and other factors in EPS development.
• To discuss the need for improved early diagnostic methods and treatment strategies for EPS.

Main Methods:

• Literature review of studies investigating the pathogenesis and risk factors of Encapsulating Peritoneal Sclerosis (EPS).
• Analysis of clinical observations and diagnostic criteria for EPS, including CT scan findings.
• Examination of the role of transforming growth factor β in EPS pathophysiology.

Main Results:

• Duration of exposure to PD fluids is identified as the primary risk factor for EPS.
• Younger age and peritonitis are suggested as additional contributing factors to EPS development.
• A distinct form of EPS post-kidney transplantation is recognized, potentially prevalent in high-transplantation rate countries.

Conclusions:

• EPS is a multifactorial condition, likely involving a 'multiple-hit' process with transforming growth factor β playing a central role.
• Current diagnostic criteria for EPS are based on symptomatic presentation and CT scans; early detection in asymptomatic patients remains a challenge.
• Further research is crucial to identify early EPS indicators, additional risk factors, and optimal treatment strategies to improve patient outcomes.