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Gastrointestinal disease in dialysis patients

INTRODUCTION

Symptoms of gastrointestinal distress are common among patients undergoing regular dialysis, with almost 80 percent of dialysis patients reporting such complaints [1]. Underlying these symptoms is an increased frequency of both upper gastrointestinal tract disorders, such as gastritis and gastroparesis, and lower gastrointestinal diseases, such as diverticular disease and colonic perforation [2-6]. Although currently rare, idiopathic dialysis ascites, also known as nephrogenic ascites, is a peculiar condition that occurs exclusively in hemodialysis patients.

A review of gastrointestinal disorders in patients on dialysis with an emphasis upon those diseases that either occur with an increased frequency or are associated with severe complications is presented here. General and detailed discussions of these disorders in patients without renal failure can be found separately.

DYSPEPSIA

Dyspepsia is a nonspecific symptom that occurs frequently in patients with end-stage renal disease (ESRD). In a study involving 102 dialysis patients, dyspepsia suggestive of a reflux, ulcer, or motility disorder was reported in 12, 19, and 17 percent of patients, respectively [1]. In this study, however, the prevalence of dyspepsia in dialysis patients was no different from the general population. (See "Approach to the adult with dyspepsia".)

Clinical considerations concerning dyspepsia caused by gastroesophageal reflux or delayed gastric emptying in patients undergoing chronic peritoneal dialysis are presented separately. (See "Noninfectious complications of continuous peritoneal dialysis".)

PEPTIC ULCER DISEASE

Although chronic renal failure was previously associated with an increased incidence of peptic ulcer disease (which is a frequent cause of dyspepsia) [7], endoscopic studies have found that the disorder is no more frequent in dialysis than in nondialysis patients [8,9]. In an endoscopic study of 114 dialysis patients, peptic ulcer was only found in two, although 51 percent had evidence of mild gastritis [9]. (See "Unusual causes of peptic ulcer disease".)

                                

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Literature review current through: Jun 2014. | This topic last updated: Jun 12, 2014.
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