Abstract
Background and Aims
Chronic kidney disease (CKD) affects gastrointestinal function and results in numerous adaptive and maladaptive responses. Disruption of the colonic microbiome and its attendant consequences - the loss of gut barrier integrity and increased generation of uremic toxins - has become well-recognized. However, less attention has been paid to characterizing the mechanisms behind the dysfunction of the upper gastrointestinal (GI) tract, largely owing to the difficulty of studying small bowel function in vivo
Method
The study included 72 people, of whom 52 made up the main group (CKD group) and 20 people - the comparison group (healthy volunteers without a kidney and cardiovascular disease). The main group consisted of patients with CKD stage 3 (RCGF creatinine 30-59ml / min / m2). The criterion for the inclusion of patients in the study, in addition to reducing the eGFR (estimated glomerular filtration rate), was the presence of arterial hypertension. The renal filtration function was the preserved comparison group and was reduced in the CKD group (p <0.001), which served as a criterion for the inclusion of patients in the study. To assess the state of the gastrointestinal tract, all patients underwent an endoscopic study with an assessment of the acidity and evacuation function of the stomach
Results
The study showed that 75% of patients had complaints of a dry and unpleasant taste in the mouth, poor appetite, aversion to meat food, nausea. These symptoms were directly related to the level of eGFR. There was also a difference in the frequency and nature of the erosive, erosive-ulcerative, ulcerative lesions of the esophagus and formation of erosions and ulcers in patients with CKD occurred significantly more often against the background of chronic gastritis and with the severity of the inflammatory process with severe dyspeptic disorders. The frequency of erosive, erosive-ulcerative and ulcerative lesions of the mucous membrane of the upper GI tract among CKD patients was 72%, which were manifested by nausea, decreased appetite, heaviness in the stomach after eating, belching, heartburn, epigastric pain (in 50% of patients), meteorism, pain in the epigastric region during palpation. Endoscopic examination of patients with CKD noted the presence of erosive esophagitis, erosive gastritis, erosive bulb it, erosive duodenitis, mixed erosive lesions, erosive-ulcerative gastritis, gastric ulcer, ulcer of duodenal ulcer. Among them, the leading place is occupied by erosive gastritis and mixed erosive lesions, which account for 22% and 27%, respectively. Hemorrhagic erosions were more common in the stomach (41%) and 12: duodenal ulcer (47%) in patients with CKD
Conclusion
Erosive, erosive-ulcerative, ulcerative lesions of the upper gastrointestinal tract occur in 76% of patients with CKD. The frequency, nature, prevalence of these lesions are associated with the treatment of CKD - active (hemodialysis) and conservative, the stage of chronic renal failure. In patients with chronic renal failure, the endoscopic picture of erosive, erosive-ulcerative, ulcerative lesions of the upper GI tract is diverse.
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