An intractable gastric ulcer which healed after eradication of Helicobacter pylori in a hemodialyzed patient

Abstract

A 45-year-old man who had end-stage renal disease due to diabetic nephropathy and had been on hemodialysis treatment for 2 years, developed a gastric ulcer. Oral administration of omeprazole in a dose of 20mg/day for 8 weeks resulted in mild improvement, but the ulcer failed to heal. Medical treatment was then switched to ranitidine, 75mg/day, but an exacerbation of the ulcer was noted during the course of ranitidine therapy. Since Helicobacter pylori was identified by culture of a biopsy specimen of the gastric mucosa, eradication of the organism was attempted. Amoxicillin in a dose of 750mg was administered orally after every hemodialysis session for 8 weeks, during which period neither an H₂-receptor antagonist nor a proton-pump inhibitor was used. Clearance of Helicobacter pylori and healing of the gastric ulcer were achieved 7 weeks after initiation of antibiotic therapy. Since then, no recurrence of the ulcer or recolonization of Helicobacter pylori has been observed for over 18 months.
Although multiple factors are thought to be involved in the pathogenesis of peptic ulcer in patients with endstage renal disease, the present case suggests that Helicobacter pylori can be a cause, or a potential contributing factor to gastric ulcer. Eradication of Helicobacter pylori with antibiotics may be the treatment of choice for intractable gastric ulcers in hemodialyzed patients.