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Upper endoscopy for occult bleeding in renal failure.

S Gupta, D L Walker, A Keshavarzian

    Journal of Clinical Gastroenterology
    |February 1, 1987
    PubMed
    Summary
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    Upper gastrointestinal endoscopy rarely explains sudden hemoglobin drops in renal failure patients. While mucosal abnormalities are common, significant occult bleeding requiring intervention is infrequent in this population.

    Area of Science:

    • Nephrology
    • Gastroenterology
    • Internal Medicine

    Background:

    • Renal failure patients often experience unexplained drops in hemoglobin (Hb) levels.
    • Upper gastrointestinal (GI) bleeding is a potential cause, but its prevalence in this cohort is unclear.
    • Assessing the diagnostic utility of upper GI endoscopy is crucial for managing these patients.

    Purpose of the Study:

    • To prospectively evaluate the effectiveness of upper GI endoscopy in identifying the cause of abrupt Hb decrease in patients with renal failure.
    • To determine the incidence of significant upper GI bleeding in patients undergoing maintenance dialysis or plasma exchange.

    Main Methods:

    • A prospective study involving 41 patients with renal failure.
    • All patients underwent upper gastrointestinal endoscopy (gastroscopy).

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  • Data collected included Hb levels, dialysis status, and endoscopic findings.

    • Main Results:

    • Only 4.9% of patients had active bleeding lesions identified during endoscopy.
    • Peptic ulcers without active bleeding were found in 12% of patients.
    • Mild upper GI mucosal abnormalities (esophagitis, gastritis, duodenitis) were common, seen in 44% of patients.

    Conclusions:

    • Clinically inapparent upper GI bleeding is an uncommon cause of sudden Hb level changes in renal failure patients.
    • While upper GI endoscopy reveals frequent mucosal abnormalities, significant bleeding is rare.
    • Endoscopy should be considered judiciously in renal failure patients presenting with unexplained Hb drops.