Clinical features of hemodialyzed patients who underwent emergent gastrointestinal endoscopy for gastrointestinal bleeding

summary of our experiences over six years

Abstract

【Background/Aims】Gastrointestinal bleeding (GIB) has been clarified to occur frequently in chronic renal failure patients, particularly in those undergoing maintenance hemodialysis (HD). In the present study, we aimed to examine the clinical features of HD patients who underwent emergent upper and/or lower gastrointestinal endoscopy (GIE) for the detection of GIB. 【Method】In total, the records of 44 HD patients who had undergone emergent GIE for GIB from January 2005 to December 2010 were retrospectively evaluated, including their symptoms, the diseases causing GIB, and recurrence. Furthermore, the patients were divided into 2 groups according to the hemoglobin (Hb) level at admission, including one group with Hb level <7.0 g/dL (n=22) and the other with Hb level ≥7.0 g/dL (n=22). The differences in the clinical parameters were examined between these 2 groups. 【Results】The GIB symptoms were melena in 26, hematemesis in 13, bloody stool in 4, and other in 1 patient. The diseases causing GIB were gastric ulcers in 13, angiodysplasia in 11, and primary gastrointestinal malignancy in 5 patients ; the disease associated with GIB could not be identified in 3 patients. The need for blood transfusion during admission and the frequency of taking a proton pump inhibitor or histamine H₂ receptor antagonist were significantly higher, and duration of hospitalization was also significantly longer in patients with Hb level <7.0 g/dL than in those with Hb ≥7.0 g/dL. However, no difference was noted in the frequency of the use of warfarin and/or anti-platelet therapy. Moreover, with regard to the disease causing GIB, a significant difference was noted between the 2 groups : angiodysplasia was more frequently noted as the disease causing GIB in patients with Hb level <7.0 g/dL, whereas primary gastrointestinal malignancy was more frequently noted as the disease causing GIB in those with Hb level ≥7.0 g/dL. 【Conclusion】 In HD patients undergoing emergent GIE for GIB, gastric and duodenal ulcers, angiodysplasia, and primary gastrointestinal malignancy would be frequently detected as the cause of GIB.