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Khan A, Mushtaq M, Movva G, Sohal A, Yang J. Gastrointestinal disease in end-stage renal disease. World J Nephrol 2025; 14:101917. [DOI: 10.5527/wjn.v14.i1.101917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2024] [Revised: 10/24/2024] [Accepted: 01/03/2025] [Indexed: 01/20/2025] Open
Abstract
When kidney function declines to a point where it can no longer maintain life and requires renal replacement therapy (i.e. renal transplant or dialysis), it is called end-stage renal disease (ESRD). Patients with ESRD often experience a range of gastrointestinal (GI) symptoms, with prevalence rates reported as high as 77%-79%. These symptoms and pathologies arise from various factors, including electrolyte imbalance, fluid imbalance, toxin buildup, uremia, medications, dietary and lifestyle restrictions, and the effects of dialysis. GI diseases in patients with renal failure can be further categorized into upper GI, small bowel, and lower GI issues. Common conditions include gastroesophageal reflux disease, nausea and vomiting, dysmotility within the esophagus and stomach, upper GI bleeding, peptic ulcer bleeding, angioectasia, irritable bowel syndrome, mesenteric ischemia, angiodysplasia, diverticular disease, constipation, pancreatitis, and diseases associated with peritoneal dialysis peritonitis and peritoneal stenosis. This review assesses the existing literature on the different GI diseases among individuals with ESRD, shedding light on their pathophysiology and prevalence.
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Affiliation(s)
- Ayesha Khan
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77550, United States
| | - Muhammad Mushtaq
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77550, United States
| | - Giri Movva
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX 77550, United States
| | - Aalam Sohal
- Gastroenterology and Hepatology, Creighton University School of Medicine, Phoenix, AZ 85012, United States
| | - Juliana Yang
- Division of Gastroenterology and Hepatology, University of Texas Medical Branch, Galveston, TX 77555, United States
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Fallone CA, Mayrand S. Gastroesophageal Reflux and Hyperacidity in Chronic Renal Failure. Perit Dial Int 2020. [DOI: 10.1177/089686080102103s52] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Carlo A. Fallone
- Division of Gastroenterology, McGill University Health Center, Montreal, Quebec, Canada
| | - Serge Mayrand
- Division of Gastroenterology, McGill University Health Center, Montreal, Quebec, Canada
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Kim DJ, Kang WH, Kim HY, Lee BH, Kim B, Lee SK, Oh DJ, Huh W, Oh HY. The Effect of Dialysate Dwell on Gastric Emptying Time in Patients on Continuous Ambulatory Peritoneal Dialysis. Perit Dial Int 2020. [DOI: 10.1177/089686089901902s28] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Methods and Patients We evaluated gastric emptying time (GET) with a technetium (Tc) 99m-sulfur colloid gastric emptying scan in 11 patients on continuous ambulatory peritoneal dialysis (CAPO) (6 males, 5 females) and in 14 controls. We investigated the effect of dialysate dwell on GET by studying the subjects twice: once without dialysate in the abdomen (drained) and once with 2 L of dialysate in the abdomen (full). We also investigated the relationship between body surface area (BSA) and delayed gastric emptying. Results (1) The mean gastric emptying rate in 120 minutes in patients on CAPO when drained (67.8% ± 13.4%) was not different from that in controls (65.4% ± 8.6%). (2) The mean gastric emptying rate in 120 minutes in patients on CAPO when full was significantly slower than that when drained (55.6% ± 14.6% versus 67.8% ± 13.4%, p < 0.05). In four of the 11 patients (36.4%), gastric emptying was extremely delayed from normal to abnormal range when full. (3) The BSA of patients who had extremely delayed GET from normal to abnormal range was smaller than that of patients who had minimal delayed or unchanged GET when full (1.5 ± 0.11 m2 versus 1.74 ± 0.22 m2). Conclusion This study showed that patients on CAPO had normal gastric emptying when drained, and that gastric emptying was delayed by dialysate dwell, especially in patients who has less than 1.5 m2 of body surface area. Therefore, we suggest that, based on adequacy, intermittent nocturnal peritoneal dialysis or a small volume of dialysate be considered for patients with small body surface area.
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Affiliation(s)
- Dae Joong Kim
- Department of Medicine, College of Medicine, Sung Kyun Kwan University, Chungbook, Korea
- Samsung Seoul Hospital, Seoul; Department of Medicine, College of Medicine, Chungbook National University, Chungbook, Korea
| | - Woo-Heon Kang
- Samsung Seoul Hospital, Seoul; Department of Medicine, College of Medicine, Chungbook National University, Chungbook, Korea
| | - Hae Young Kim
- Samsung Seoul Hospital, Seoul; Department of Medicine, College of Medicine, Chungbook National University, Chungbook, Korea
| | - Bang Hoon Lee
- Samsung Seoul Hospital, Seoul; Department of Medicine, College of Medicine, Chungbook National University, Chungbook, Korea
| | - Bum Kim
- Samsung Seoul Hospital, Seoul; Department of Medicine, College of Medicine, Chungbook National University, Chungbook, Korea
| | - Sung Ku Lee
- Samsung Seoul Hospital, Seoul; Department of Medicine, College of Medicine, Chungbook National University, Chungbook, Korea
| | - Dong Jin Oh
- Samsung Seoul Hospital, Seoul; Department of Medicine, College of Medicine, Chungbook National University, Chungbook, Korea
| | - Wooseong Huh
- Samsung Seoul Hospital, Seoul; Department of Medicine, College of Medicine, Chungbook National University, Chungbook, Korea
| | - Ha-Young Oh
- Department of Medicine, College of Medicine, Sung Kyun Kwan University, Chungbook, Korea
- Samsung Seoul Hospital, Seoul; Department of Medicine, College of Medicine, Chungbook National University, Chungbook, Korea
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Salles Junior LD, Santos PR, dos Santos AA, de Souza MHLP. Dyspepsia and gastric emptying in end-stage renal disease patients on hemodialysis. BMC Nephrol 2013; 14:275. [PMID: 24330675 PMCID: PMC3867417 DOI: 10.1186/1471-2369-14-275] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Accepted: 12/11/2013] [Indexed: 12/31/2022] Open
Abstract
Background Dyspepsia is common among end-stage renal disease (ESRD) patients and its association with delayed gastric emptying is not well established. We assessed the association of dyspepsia with gastric emptying time in ESRD patients undergoing hemodialysis (HD). Methods Dyspepsia was assessed through the Porto Alegre Dyspeptic Symptoms Questionnaire (PADYQ). PADYQ’s scores ≥ 6 classified participants as dyspeptic. The octanoic acid breath test using 13carbon was employed to assess the gastric emptying time. Based on the test, time in minutes to metabolize the first half of the 13carbon in the test meal (t1/2) was calculated. Association of dyspepsia with gastric emptying time was tested by the correlation between PADYQ scores and t1/2, and also by comparing t1/2 between dyspeptics and non-dyspeptics. Results There were 34 (68.0%) dyspeptic patients. Dyspepsia score was positively correlated with t1/2 (r = 0.366; p = 0.009). Dyspeptics had longer t1/2 compared to non-dyspeptics, respectively, 238.0 ± 92.9 versus 185.5 ± 45.5 minutes (p = 0.042). Conclusions Delayed gastric emptying was associated with dyspepsia. Prokinetic medications could have a role in preventing or relieving dyspeptic symptoms among HD patients. Future research in larger samples is necessary to confirm this association.
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Affiliation(s)
| | - Paulo Roberto Santos
- Sobral School of Medicine, Federal University of Ceará, Avenida Comandante Maurocélio Rocha Ponte, 100 - CEP 62,042-280, Sobral, CE, Brazil.
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Shirazian S, Radhakrishnan J. Gastrointestinal disorders and renal failure: exploring the connection. Nat Rev Nephrol 2010; 6:480-92. [PMID: 20606629 DOI: 10.1038/nrneph.2010.84] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Gastrointestinal complications are known to commonly occur in patients with renal failure. Uremia and dialysis have long been speculated to increase the risk of lesions in the gastrointestinal tract and accessory organs. In addition, gastrointestinal procedures such as gastrointestinal bypass surgery and the administration of colonoscopy preparations can lead to the development of renal complications. Results from studies that have attempted to define the association between renal dysfunction and gastrointestinal complications are, however, conflicting and limited by small and varied sample populations. No clear management guidelines currently exist for many of the gastrointestinal problems that accompany renal failure. This Review examines the existing data on gastrointestinal complications in patients with chronic kidney disease and end-stage renal disease and aims to outline the etiology and management of common gastrointestinal disorders in such patients.
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Affiliation(s)
- Shayan Shirazian
- Division of Nephrology, Columbia University Medical Center, 622 W 168th Street, PH4-124, New York, NY 10032, USA
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Cano AE, Neil AK, Kang JY, Barnabas A, Eastwood JB, Nelson SR, Hartley I, Maxwell D. Gastrointestinal symptoms in patients with end-stage renal disease undergoing treatment by hemodialysis or peritoneal dialysis. Am J Gastroenterol 2007; 102:1990-7. [PMID: 17511755 DOI: 10.1111/j.1572-0241.2007.01321.x] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The aim of this study was to determine the prevalence of gastrointestinal symptoms in patients with end-stage renal disease undergoing hemodialysis (HD) or peritoneal dialysis (PD) treatment. METHODS Patients undergoing HD or chronic ambulatory PD in the Department of Renal Medicine of our hospital were asked to complete a locally validated Rome II questionnaire. The same questionnaire was also administered to age- and gender-matched medical outpatients without renal failure, and community subjects. Patients on HD and their outpatient controls also completed the Hospital Anxiety and Depression Scale. RESULTS A total of 148 patients with end-stage renal disease (HD 100, PD 48) completed the study. Their results were compared with those of 148 age- and gender-matched medical outpatients without renal failure and 148 randomly selected community controls. Patients on dialysis treatment were more likely to have abdominal pain, use laxatives, and report symptoms consistent with functional vomiting and irritable bowel syndrome (IBS) (70%, 55%, 16%, and 25%) than age- and gender-matched medical outpatients without renal failure (21%, 11%, 1%, and 6%) and community controls (16%, 4%, 0%, and 8%). Among HD patients and their outpatient controls, the differences appeared to be unrelated to anxiety or depression. CONCLUSIONS Abdominal pain, laxative use, functional vomiting, and IBS were more common in uremic individuals than in controls without renal failure. Our data have not shown whether these differences are due to the uremic state itself, or, alternatively, its treatment.
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Affiliation(s)
- Alicia E Cano
- Department of Gastroenterology, St George's Hospital, London, UK
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Abstract
Patients with chronic kidney disease (CKD) are at high risk for adverse drug reactions and drug-drug interactions. Drug dosing in these patients often proves to be a difficult task. Renal dysfunction-induced changes in human pathophysiology regularly results may alter medication pharmacodynamics and handling. Several pharmacokinetic parameters are adversely affected by CKD, secondary to a reduced oral absorption and glomerular filtration; altered tubular secretion; and reabsorption and changes in intestinal, hepatic, and renal metabolism. In general, drug dosing can be accomplished by multiple methods; however, the most common recommendations are often to reduce the dose or expand the dosing interval, or use both methods simultaneously. Some medications need to be avoided all together in CKD either because of lack of efficacy or increased risk of toxicity. Nevertheless, specific recommendations are available for dosing of certain medications and are an important resource, because most are based on clinical or pharmacokinetic trials.
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Affiliation(s)
- Steven Gabardi
- Department of Pharmacy Services, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115-6110, USA.
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Lin X, Mellow MH, Southmayd L, Pan J, Chen JD. Impaired gastric myoelectrical activity in patients with chronic renal failure. Dig Dis Sci 1997; 42:898-906. [PMID: 9149040 DOI: 10.1023/a:1018856112765] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Dysmotility and delayed emptying of the stomach have been reported in patients with chronic renal failure (CRF). The aim of this study was to investigate whether gastric myoelectrical activity was impaired in patients with CRF using electrogastrography. The electrogastrogram (EGG) was recorded in 24 symptomatic patients with CRF (15 with diabetes) and 12 normal subjects. Two 30-min EGG recordings before and after a test meal were analyzed using spectral analysis methods. It was found that patients with CRF showed a significantly lower percentage of normal 2-4 cpm slow waves in both fasting and fed states in comparison with healthy controls (in fasting state: 88.9 +/- 2.5% vs 67.4 +/- 6.6%/63.2 +/- 7.0%, P < 0.01; in fed state: 89.6 +/- 1.8% vs 64.6 +/- 6.2%/62.0 +/- 8.3%, P < 0.01; controls vs diabetic patients/nondiabetic patients). Both patient groups showed a significantly higher prevalence of the abnormal EGG, which was defined as the percentage of 2-4 cpm slow waves lower than 70% (fasting state: 8% vs 60%/56%, P < 0.01/0.05; fed state: 0% vs 53%/56%, P < 0.005/0.002; controls vs diabetic patients/nondiabetic patients). No significant difference was observed in the regularity of the gastric slow waves between the two patient groups. The healthy controls showed a significant increase in the dominant power and frequency of the EGG after the test meal. However, this increase was absent in the two patient groups. It was concluded that patients with chronic renal failure have abnormal gastric myoelectrical activity, including impaired regularity of the gastric slow wave and a failed increase in the power of the EGG at 3 cpm. Electrogastrography is an attractive noninvasive method for the study of gastric motility in patients with severe chronic renal failure.
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Affiliation(s)
- X Lin
- Thomas N. Lynn Institute for Healthcare Research, Integris Baptist Medical Center, Oklahoma City, Oklahoma 73112, USA
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Abstract
Feeding problems, anorexia and vomiting are common in infants and children with chronic renal failure (CRF), and play a major role in the growth failure often found in this condition. However, the gastroenterological and nutritional aspects of CRF in children have received little attention, hence therapeutic interventions are usually empirical and often ineffective. Gastritis, duodenitis and peptic ulcer are often found in adults with CRF on regular haemodialysis and following renal transplantation. Despite persistent hypergastrinaemia, gastric acid secretion is decreased rather than increased in most of these patients, and active peptic disease appears to be promoted by the removal of the acid output inhibition (neutralisation of gastric acid by ammonia) that follows active treatment. Helicobacter pylori, on the other hand, does not seem to play a significant role in the pathogenesis of peptic disease in CRF. Gastro-oesophageal reflux has been found in about 70% of infants and children with CRF suffering from vomiting and feeding problems, and thus appears to be a major problem in these patients. In a number of symptomatic patients with CRF, gastric dysrhythmias and delayed gastric emptying have also been found; hence there appears to be a complex disorder of gastrointestinal motility in CRF. Serum levels of several polypeptide hormones involved in the modulation of gastrointestinal motility [e.g. gastrin, cholecystokinin (CCK), neurotensin] and the regulation of hunger and satiety (e.g. glucagon, CCK) are significantly raised as a consequence of renal insufficiency, and can be reverted to normal by renal transplantation. Furthermore, several other humoral abnormalities (e.g. hypercalcaemia, hypokalaemia, acidosis, etc.) are not uncommon in CRF. By directly affecting the smooth muscle of the gut or stimulating particular areas within the central nervous system, all these humoral alterations may well play a major role in the gastrointestinal dysmotility, anorexia, nausea and vomiting in patients with CRF. Specific pharmacological and nutritional interventions should thus be considered for the treatment of vomiting and feeding problems in CRF.
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Affiliation(s)
- A M Ravelli
- Department of Paediatrics, University of Brescia, Italy
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10
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Kao CH, Hsu YH, Wang SJ. Delayed gastric emptying and Helicobacter pylori infection in patients with chronic renal failure. EUROPEAN JOURNAL OF NUCLEAR MEDICINE 1995; 22:1282-5. [PMID: 8575478 DOI: 10.1007/bf00801614] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Forty patients with chronic renal failure (CRF) were enrolled in this study. Twelve of the 40 patients had upper gastrointestinal symptoms or signs (GI Sx). Twenty of the 40 patients had been receiving regular haemodialysis (HD) for at least 1 year prior to the study. Radionuclide-labelled solid meals were used to calculate gastric emptying times (GETs). The carbon-14 urea breath test (14C4-UBT) was used to diagnose Helicobacter pylori (HP) infection. Among the 40 patients, 35 (88%) had an abnormal GET and 22 (55%) had a positive 14C-UBT for HP infection. There were no statistically significant differences in the incidence of abnormal GET among patients with HP infection and patients without HP infection. There were also no significant differences in the incidence of HP infection among patients with abnormal and normal GETs. In addition, the incidences of abnormal GET in patients with and without upper GI Sx were 83% and 89% respectively. The incidences of HP infection in patients with and without upper GI Sx were 58% and 54%, respectively. The incidences of abnormal GET in HD and non-HD patients were 95% and 80%, respectively. The incidences of HP infection in HD and non-HD patients were 45% and 65%, respectively. The differences in the incidences of abnormal GET and HP infection among HD and non-HD patients, as well as among patients with and without upper GI Sx, were not statistically significant.
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Affiliation(s)
- C H Kao
- Department of Nuclear Medicine, Taichung Veterans General Hospital, Taichung, and Yang-Ming University, Taipei, Taiwan, Republic of China
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Nowak TV, Johnson CP, Kalbfleisch JH, Roza AM, Wood CM, Weisbruch JP, Soergel KH. Highly variable gastric emptying in patients with insulin dependent diabetes mellitus. Gut 1995; 37:23-9. [PMID: 7672674 PMCID: PMC1382762 DOI: 10.1136/gut.37.1.23] [Citation(s) in RCA: 90] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Some diabetic patients--particularly those with nausea and vomiting--frequently have evidence of delayed gastric emptying while other diabetic patients may in fact exhibit accelerated gastric emptying. Whether the presence or absence of symptoms of upper gastrointestinal dysfunction correlated with objective measures of gastric emptying in insulin dependent diabetic subjects was investigated. Twenty one insulin dependent diabetic patients underwent a solid phase gastric emptying scintiscan using in vivo labelled chicken liver. Thirteen patients had symptoms suggestive of gastrointestinal dysfunction (nausea, vomiting, early satiety, or constipation), while eight patients had no gastrointestinal symptoms. Eleven patients had orthostatic hypotension. All patients had been diabetic since childhood or adolescence. As a group, the diabetic patients showed a half time (T50) of gastric emptying (mean (SD) 150.0 min (163.7) that was not significantly different from that of 12 healthy control subjects (148.1 min (62.4)). Those diabetic patients without gastrointestinal symptoms and without orthostatic hypotension, however, showed a gastric emptying half time (70.1 min (41.6)) that was significantly faster than that of the control subjects. Conversely, those diabetic patients with nausea, vomiting, and early satiety (or early satiety alone) showed T50 values that were significantly greater than those of the diabetic patients without these symptoms. No correlation was found between the T50 value and the duration of diabetes, the fasting blood glucose at the time of study, or the respiratory variation in heart rate (E:I ratio). These observations indicate that highly variable rates of gastric emptying occur in insulin dependent diabetic patients, and that accelerated gastric emptying may occur in diabetic patients who have no symptoms of gastrointestinal dysfunction.
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Affiliation(s)
- T V Nowak
- Indiana University Medical Center, Department of Medicine, Indianapolis, USA
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Dumitrascu DL, Barnert J, Kirschner T, Wienbeck M. Antral emptying of semisolid meal measured by real-time ultrasonography in chronic renal failure. Dig Dis Sci 1995; 40:636-44. [PMID: 7895559 DOI: 10.1007/bf02064384] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The etiology of upper digestive complaints in uremic patients, which frequently cause morbidity, is unclear. By means of ultrasonography we studied the emptying of the gastric antrum in 15 patients suffering from end-stage renal disease and in 15 controls. In addition, we tested for autonomic neuropathy in the chronic renal failure (CRF) patients using cardiovascular tests. The antral filling and emptying of a semisolid standardized test meal was assessed by measuring cross-sectional areas of the antrum along the plane of the mesenteric vein at regular intervals after a semisolid test meal. Postprandial antral cross-sectional areas were similar in controls and in the total of the renal failure patients. CRF patients without autonomic neuropathy (4/15) showed hastened antral emptying as evidenced by significantly diminished postcibal antral expansion. Only the CRF subgroup with symptoms of both parasympathetic plus sympathetic autonomic neuropathy (6/15) had delayed antral emptying compared to controls as assessed by planimetry of the area under the curve in postprandial antral cross-sectional areas. The CRF subgroup with exclusively parasympathetic neuropathy (5/15) had antral emptying similar to the controls. The symptom score as assessed by a standardized questionnaire of the CRF group with autonomic neuropathy (11/15) correlated significantly both with the fasting antral cross-sectional area and inversely with antral expansion immediately after finishing the test meal. Antral emptying showed a trend towards an inverse relationship to the symptom score, which reached statistical significance only in the CRF subgroup with sympathetic plus parasympathetic autonomic damage.(ABSTRACT TRUNCATED AT 250 WORDS)
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Abstract
Gastrointestinal mucosal abnormalities ranging from edema to ulceration occur in two thirds of patients dying of uremia. Early studies suggested that uremic patients on maintenance dialysis treatment were at increased risk of peptic ulceration but more recent data indicate that this is not so. Other gastrointestinal problems reported for uremic subjects on maintenance dialysis treatment include bleeding from telangiectatic lesions, constipation, mucosal deposition of amyloid and acute pancreatitis. Nausea and vomiting are common in the uremic patient but gastric emptying studies have yielded conflicting results. Patients undergoing renal transplantation are at increased risk of development of esophagitis, complicated peptic ulcer, intestinal ulceration, and perforation as well as acute pancreatitis.
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Affiliation(s)
- J Y Kang
- Department of Medicine, National University Hospital, Singapore
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Ravelli AM, Ledermann SE, Bisset WM, Trompeter RS, Barratt TM, Milla PJ. Foregut motor function in chronic renal failure. Arch Dis Child 1992; 67:1343-7. [PMID: 1471884 PMCID: PMC1793783 DOI: 10.1136/adc.67.11.1343] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
In children with chronic renal failure (CRF) anorexia, nausea, and vomiting are common yet poorly understood symptoms. We studied oesophageal and gastric motor function in 12 children (age 7 months-6.8 years) with severe CRF not undergoing dialysis who had persistent anorexia and vomiting. Eight of 12 patients had significant gastro-oesophageal reflux (reflux index 5.2% to 21.9%, mean 11.3%; controls < 5%), 7/10 had altered gastric half emptying times (T1/2) for 5% glucose or milk (glucose meal--controls: 8-14 min, two CRF patients: 18-25 min; milk meal--controls: 48-72 min, five CRF patients 27, 28, 82, 83, and 110 min). Gastric antral electrical control activity was abnormal in 6/11 patients, with different types of gastric dysrhythmias whereas the remainder and controls showed a regular dominant frequency of 0.05 Hz. In 7/9 patients fasting serum gastrin concentration was raised (53 to > 400, mean 168 pmol/l, controls < 40 pmol/l). All CRF patients with anorexia and vomiting had one or more disorder of foregut motility. The nature and variety of the motor disorders and the raised concentrations of circulating gastrin suggest that the normal environment generated by CRF affects the function of the smooth muscle of the foregut.
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Affiliation(s)
- A M Ravelli
- Medical Unit, Institute of Child Health, London
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Brown-Cartwright D, Smith HJ, Feldman M. Gastric emptying of an indigestible solid in patients with end-stage renal disease on continuous ambulatory peritoneal dialysis. Gastroenterology 1988; 95:49-51. [PMID: 3371624 DOI: 10.1016/0016-5085(88)90289-2] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Using radiopaque markers, we evaluated gastric emptying in 10 male patients with end-stage renal disease on continuous ambulatory peritoneal dialysis and in 15 normal men. Dialysis patients were studied twice, once without peritoneal dialysate in the abdomen (drained) and once with 2 L of dialysate in the abdomen (full). Each normal man and 9 of 10 dialysis patients, when drained, emptied all 10 markers by 6 h after a test meal. In contrast, 5 of the 10 dialysis patients, when full, had delayed emptying of radiopaque markers. Thus, continuous ambulatory dialysis may delay gastric emptying of indigestible solids.
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Affiliation(s)
- D Brown-Cartwright
- Department of Internal Medicine, Dallas Veterans Administration Medical Center, Texas
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