Upper endoscopy for occult bleeding in renal failure

We studied 41 patients with renal failure prospectively to assess the value of upper gastrointestinal endoscopy in detecting occult bleeding after an abrupt fall in hemoglobin (Hb) level. Thirty-four patients were on maintenance dialysis, six on plasma exchange, and one on dialysis and plasma exchange. At gastroscopy two patients (4.9%) had bleeding lesions, five patients (12%) peptic ulcers without bleeding, and 18 patients (44%) mild esophagitis, gastritis, or duodenitis. Although mucosal abnormalities in the upper gastrointestinal tract were common, clinically inapparent gastrointestinal bleeding was only rarely responsible for sudden changes of Hb in these patients.