HDCN Article Review/Hyperlink

Tamura H, Tokushima H, Murakawa M, Matsumura O, Itoyama S, et al.

Eradication of Helicobacter pylori in patients with end- stage renal disease under dialysis treatment

Am J Kidney Dis (Jan) 29:86-90 1997

H. pylori is the cause of most peptic ulcers and may be the etiology of other upper GI disorders. Although patients with ESRD frequently have upper GI complications, the prevalence of this infection appears to be the same in ESRD as in patients with normal renal function. In this study, the combination of amoxicillin, lansoprazole (a proton pump inhibitor), and plaunotol (a cytoprotective agent derived from a Thai tree) was evaluated in 15 patients with dyspepsia and documented H. pylori infection. H pylori infection was confirmed by positive results on culture, histology, and urease testing (2 of 3 studies needed to be positive for study inclusion). H. pylori was eradicated in 11/14 patients. One patient dropped out of the study because of nausea and diarrhea. Gastric juice ammonia levels were markedly decreased (to about 10% of baseline values) in patients who became H. pylori negative after successful treatment. Serum gastrin levels also were decrased (about 50%) with successful treatment. This regimen appears to be very effective in ESRD patients.

Comment: These are good results but of course obtained with a regimen that is not available in the U.S. An interesting finding is that the increased gastric juice ammonia concentration in ESRD patients was markedly decreased by eradication of H. pylori . It appears that H. pylori infection (in combination with increased urea concentration in ESRD) may cause the elevated gastric ammonia. (David J. Leehey, M.D., Loyola University at Chicago)

The abstract to this paper is available from at this site.