Severe gastric lesions due to Helicobacter pylori infection in two patients undergoing hemodialysis

Patients receiving hemodialysis (HD) have a higher risk of gastroduodenal disorders due to high urea levels, decline of gastrointestinal motility, amyloid protein deposition and Helicobacter pylori (HP) infection.1,2 Although HP infection has been associated with peptic ulcer, gastric cancer and gastric lymphoma,1–3 the appropriate, prompt and non-invasive procedures for its diagnosis have still not been defined in patients undergoing HD.3 We present the upper endoscopical pictures of two patients (50 and 52 years old on maintenance HD for three and five years, respectively) showing intensely frail and red gastric mucus with serious nodular configuration (Figure 1). Although they had presented minor and occasional symptoms of gastritis during the last years, the endoscopical findings showed an advanced stage, alarming for lymphoma or fundic gland polyps. Interestingly, the biopsies showed severe HP pangastritis with lymphocytic infiltrations and microerosions grade 3 by Wotherspoon. Patients on HD are reluctant to perform endoscopic checkups (these particular patients underwent upper endoscopy only because it was a prerequisite for getting into the transplantation list) and physicians rarely deem HP infection a cause of gastric symptoms in this patient group. Our report indicates that HP infection should be more often considered in the differential diagnosis of gastrointestinal symptoms in patients on HD and non-invasive methods should be determined for its early detection.

Figure 1. Upper endoscopic pictures of two patients on maintenance hemodialysis, showing intensely frail and red gastric mucus with serious nodular configuration.