Eradication of Helicobacter pylori Restores Elevation of Serum Gastrin Concentrations in Patients with End-Stage Renal Disease.

Abstract

In order to explore the role ofHelicobacterpylori (H. pylori) infection in hypergastrinemia in patients on dialysis, the changes in serum gastrin concentration were examinedbefore and after eradication treatment for H. pylori. Twenty-seven patients on dialysis were treated for the eradication of H. pylori Fasting serum gastrin concentrations were measured by a radioimmunoassay which detects gastrin 17. Ammoniaand pHlevels of the gastricjuice were also measured. The serum gastrin concentrations were significantly decreased following eradication of if. pylori, and the meanvalue reached the normalrange. The restoration ofhypergastrinemiawas associated with marked reductions of gastric juice ammonia and pH levels. In contrast, patients in whomH. pylori was not eradicated showed no changes in these parameters. In conclusion, the elevation of the fasting serum gastrin 17 concentration seen in dialysis patients appeared to be attributable to H. pylori infection in the stomach.

Review of Helicobacter pylori Infection and Chronic Renal Failure

“…In fact, 36.4% of patients with end-stage renal disease are reported to have clarithromycin-resistant strains, which is significantly higher than in non-uremic controls (15.2%) (69). As summarized in Table 4 (4,28,31,32,35,38,46,(70)(71)(72)(73)(74)(75), each eradication regimen previously reported use of different PPIs (omeprazole, lansopprazole, esomeprazole) and/or antibiotics (clarithromycin, amoxicillin and metronidazole), and variation of the duration of treatment from 7 days to more than 3 weeks. However, there is no significant difference in the overall cure rates among the different studies listed.…”

“…As summarized in Table 4(4,28,31,32,35,38,46,70–75), each eradication regimen previously reported use of different PPIs (omeprazole, lansopprazole, esomeprazole) and/or antibiotics (clarithromycin, amoxicillin and metronidazole), and variation of the duration of treatment from 7 days to more than 3 weeks. However, there is no significant difference in the overall cure rates among the different studies listed.…”

“…Because amoxicillin is mainly excreted from the kidney, toxic effects of amoxicillin on renal function in patients with chronic renal failure have been reported in various studies (76,77). However, most previous reports showed no severe adverse effects of amoxicillin in hemodialysis patients who received eradication therapy containing amoxicillin (4,28,31,32,35,38,70,71). Moreover, since PPI and antibiotics are removed by hemodialysis, plasma concentration of PPI and antibiotics is expected to decrease to a concentration that is less than effective.…”

Recurrence of peptic ulcer in uraemic and non‐uraemic patients after Helicobacter pylori eradication: a 2‐year study

“…However, the prevalence of H. pylori infection in these patients seems to be lower than that in the general population 7–12 . Although H. pylori infection is closely associated with peptic ulcer, the effect of its eradication on the recurrence of peptic ulcer in patients with ESRD remains unclear so far 13, 14 …”

Chronic Hypergastrinemia: Causes and Consequences

“…By the late1980s, chronic hypergastrinemia was recognized with increasing frequency due to its association with gastric infection with Helicobacter pylori, and more importantly to the widespread availability of potent inhibitors of gastric acid secretion with proton pump inhibitors (PPIs) [3][4][5][6][7]. Unlike what was seen in preceding decades, PPIs produced a more modest elevation in gastrin ( ∼200-400 pg/mL) and was not associated, in humans, with any apparent serious pathology [8][9][10][11].…”