Giant peptic ulcers in patients undergoing maintenance hemodialysis

The aim of the study was to investigate the clinical characteristics of hemodialyzed uremic patients with upper gastrointestinal lesions. A total of 20 (7.2%) out of 276 patients on hemodialysis program underwent endoscopy and rentgenography of the upper gastrointestinal tract. The incidence of peptic ulcer disease in the patients with end-stage renal disease was 4.3%. Six (30%) out of 20 uremic hemodialyzed patients with gastrointestinal complications had giant peptic ulcers of duodenum or prepyloric area. In three (50%) out of six subjects, giant peptic ulcers were located in the second portion of the duodenum. Gastrointestinal hemorrhagic complications occurred in 12 (60%) patients. The most frequent sources of bleeding were duodenal ulcers alone (8 patients) or in combination with gastric and/or duodenal flat erosions (6 patients), angiodysplasia of the duodenum (3 patients) and duodenal erosions (one patient). Two patients with bleeding from giant ulcers died from perforation and hemorrhagic shock. The uremic hemodialyzed patients with giant ulcers were older than 65, had higher basal gastrin concentration (305.3 +/- 183.8 pmol/l), and lower basal (1.6 +/- 0.16 mmol/h) and stimulated gastric acid secretion (14.4 +/- 8.63 mmol/h).