Gastrointestinal Disorders in Peritoneal Dialysis Patients

Abstract

Background: Gastrointestinal (GI) disorders in peritoneal dialysis (PD) patients are relatively understudied in the literature, even though they have a serious impact in the morbidity parameters and the quality of life for this group of patients. Various diagnostic tools have been used, including instrumental methods and questionnaires, invariably validated in comparative studies. Summary: The prevalence of GI disorders is very high in PD patients. Compared to the haemodialysis patients they present a higher prevalence of reflux, eating dysfunction, gastroesophageal reflux, intestinal obstruction or adhesions and abdominal hernia. They may be divided into Gastric disorders (Gastroesophageal reflux disease, pathological Gastric emptying, Dyspepsia, Helicobacter pylori infection, peptic ulcers) and Intestinal disorders (Peritonitis, Diverticulosis, Constipation). Key Messages: The current paper is a review of the literature involving GI disorders in PD patients. This special group of patients with a special role of the peritoneal cavity and the GI motility in the physiology of their dialysis merit a larger number of studies dealing with the interrelation of the GI tract and the PD physiological, functional and pathophysiological parameters.

When ESKD complicates disease management: GI bleeding and other GI illnesses

“…This is thought to be due to increased intra‐abdominal pressure while doing PD, particularly when patients are supine. However, other studies show no significant difference in symptoms between these modalities 12 . The data obtained in these studies are subjective.…”

“…Patients with intradialytic hypotension and concern for ischemic colitis may also benefit from transition to PD or frequent home hemodialysis where the ultrafiltrate rate is lower. However, overall rates for mesenteric ischemia are similar in HD and PD 12 …”

“…The data obtained in these studies are subjective. Objective data have been collected to show that gastric emptying is slower in patients on PD than those on HD 12–14 . This delayed emptying is higher when dialysate is present in the peritoneum but persists even when the dialysate has been drained.…”

“…This delayed emptying is higher when dialysate is present in the peritoneum but persists even when the dialysate has been drained. Dextrose‐based dialysate solutions slow gastric motility more than icodextrin‐based dialysate solutions 12,14 . This suggests that the difference is not solely due to the presence of fluid in the peritoneum but may relate to the nature of ultrafiltration, which is faster with dextrose and slower with icodextrin.…”

“…This suggests that the difference is not solely due to the presence of fluid in the peritoneum but may relate to the nature of ultrafiltration, which is faster with dextrose and slower with icodextrin. In addition to volume and pressure, the caloric content of dextrose‐containing solutions likely contributes to prolonged gastric emptying times 12–14 . The presence of substantial RKF may allow PD regimens that improve gastric emptying such as smaller fill volumes and dry periods.…”