Abstract
To determine if patients undergoing regular hemodialysis (HD) have less gastric atrophy related with aging as compared with age-matched healthy subjects, we studied histological findings of the gastric mucosa endoscopically obtained from 6 standardized points (i. e., the lesser curvature of the antrum, angle, the lower body and upper body, and the greater curvature of the upper and middle body) in 39 patients undergoing regular hemodialysis and 31 age-matched healthy subjects. The width of the oxyntic gastric gland area was calculated by the formula of the histological scoring system [i. e., index of oxyntic gland area (IOGA)]. In addition, we studied correlations between TOGA and several clinical and biochemical parameters [i. e., serum levels of gastrin, parathyroid hormone (PTH) and calcium, patients' ages when studied, patients' ages when HD was initiated, durations of HD]. We found that patients undergoing regular HD had wider oxyntic gland areas than age-matched healthy subjects, and more than half of HD patients had cobble-stone appearance on the oxyntic mucosa, being compatible with so-called endoscopically hypertrophic gastric mucosa. Because oxyntic gland area is known to become small by aging, it was suggested that HD patients may have younger stomach for their age. We also found that there were significant (p<0.05 or 0.01) negative correlations between IOGA and the serum gastrin level, patients' current age and patients' ages when HD was initiated. However, no significant correlations were observed between IOGA and the duration of HD, serum levels of PTH and calcium in our HD patients. In conclusion, these data suggested that patients undergoing regular HD may have wider oxyntic gland areas for their ages, and that hypergastrinemia frequently observed in HD patients was not likely to be a causal factor of the HD-related histological alternation in the gastric mucosa (i. e., younger stomach). Further studies are required to determine if other endogenous trophic factors (e. g., epidermal growth factor, pancreatic glucagon, cholecystokinin-pancreozymin) and causal factors of chronic atrophic gastritis (e. g., Helicobacter pylori, bile salt) might be contributing to the gastric mucosal alternation related with HD described as above.
