Helicobacter pylori and uremic gastritis: a histopathologic study and a correlation with endoscopic and bacteriologic...

In this work 70 asymptomatic uremic patients under maintenance hemodialysis in our institution underwent upper-gastrointestinal endoscopy as part of a routine investigation prior to kidney transplantation. Their endoscopic findings were scored and antral mucosal biopsies were obtained and subjected to histopathologic and bacteriologic assessment. Bacteriologic examination included culture, rapid urease test, and microscopic examination for detection of Helicobacter pylori. Histopathologic examination of the gastric mucosa showed chronic superficial gastritis in 52%, atrophic gastritis in 5.7% and intestinal metaplasia in 37% of the cases. Of the cases with superficial gastritis, 5 showed in addition gastric mucosal dysplastic changes. There was no correlation between the histopathologic and endoscopic findings. Nevertheless, there was a significant association between histopathologic changes and H. pylori infection (p = 0.0001). All cases with atrophic gastritis showed H. pylori, and of 24 cases with chronic active superficial gastritis. H. pylori was detected in 18, while it was detected in only 2 of 13 cases with chronic inactive superficial gastritis and in 4 of 29 cases with normal antral mucosal biopsies. Among different variables in dialysis patients, only patients' ages were found to have significant association with H. pylori infection (p < 0.03). We have concluded that in asymptomatic uremic patients under maintenance hemodialysis, relying only on endoscopy for critical assessment of the upper gastrointestinal tract is unsatisfactory and histopathologic examination of the antral mucosal biopsies is mandatory. Chronic superficial gastritis and atrophic gastritis should be expected in up to 60% of the patients, and there is a strong association between H. pylori infection and gastritis.