Unique aspects of gastrointestinal disease in dialysis patients
- Thomas A Golper, MD
Thomas A Golper, MD
- Section Editor — Dialysis
- Professor of Medicine
- Vanderbilt University Medical Center
- Lawrence S Friedman, MD
Lawrence S Friedman, MD
- Section Editor — General Gastroenterology
- Professor of Medicine
- Harvard Medical School
- Tufts University School of Medicine
- Section Editor
- Jeffrey S Berns, MD
Jeffrey S Berns, MD
- Editor-in-Chief — Nephrology
- Section Editor — Dialysis
- Professor of Medicine
- Perelman School of Medicine at the University of Pennsylvania
- Deputy Editors
- Alice M Sheridan, MD
Alice M Sheridan, MD
- Deputy Editor — Nephrology
- Assistant Professor of Medicine
- Harvard Medical School
- Shilpa Grover, MD, MPH, AGAF
Shilpa Grover, MD, MPH, AGAF
- Deputy Editor — Gastroenterology/Hepatology
- Assistant Professor of Medicine, Part-time
- Harvard Medical School
Gastrointestinal (GI) symptoms are reported in up to 80 percent of dialysis patients [1-3]. This topic reviews GI disorders that occur with a higher prevalence or have clinical features that are unique dialysis patients. We also discuss management considerations that are specific to GI diseases in patients on dialysis.
ESOPHAGUS AND STOMACH
Angiodysplasia — Angiodysplasias are the most common vascular anomalies encountered in the GI tract. While their presentation and management are in most respects similar to the non-end-stage renal disease (ESRD) population, patients with ESRD and chronic GI bleeding may benefit from estrogen therapy.
●Prevalence – Angiodysplasias account for approximately 20 and 30 percent of episodes of upper and lower GI bleeding, respectively, and for approximately one-half of recurrent episodes of upper GI bleeding in patients with ESRD . It is unclear if the prevalence of angiodysplasia is higher among ESRD patients as compared with the general population or if angiodysplastic lesions are detected more frequently in patients on hemodialysis due to exposure to anticoagulants and uremia-induced platelet dysfunction [4-7]. (See "Angiodysplasia of the gastrointestinal tract" and "Angiodysplasia of the gastrointestinal tract", section on 'End-stage renal disease'.)
●Clinical presentation and diagnosis – Patients usually present with chronic GI bleeding, although severe acute bleeding may also occur. Angiodysplastic lesions may also be found incidentally during endoscopic evaluation performed for other indications. The clinical presentation and diagnosis of angiodysplasia of the GI tract are discussed elsewhere. (See "Angiodysplasia of the gastrointestinal tract", section on 'Clinical manifestations' and "Angiodysplasia of the gastrointestinal tract", section on 'Diagnosis'.)
●Management – Dialysis patients with chronic GI bleeding can benefit from administration of conjugated estrogens. Small case series have suggested that estrogens may prevent recurrent bleeding from angiodysplasia and reduce transfusion requirements [8,9]. The management of GI bleeding in dialysis patients is otherwise similar to nondialysis patients and is discussed in detail separately. (See "Approach to acute upper gastrointestinal bleeding in adults" and "Platelet dysfunction in uremia", section on 'Estrogen'.)To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- ESOPHAGUS AND STOMACH
- Esophageal varices
- Acute pancreatitis
- Exocrine pancreatic insufficiency/chronic pancreatitis
- SMALL INTESTINE AND COLON
- Intestinal ischemia
- Constipation/fecal impaction
- Acute diverticulitis
- Other rare gastrointestinal diseases
- Bowel preparation for lower gastrointestinal endoscopy
- Hemodialysis-associated ascites
- SUMMARY AND RECOMMENDATIONS