Hypochlorhydria and Hypergastrinemia and Their Association with Gastrointestinal Bleeding in Undialyzed and Hemodialyzed Patients

Abstract

In 15 undialyzed (UD) patients and 26 hemodialyzed (HD) patients, (1) basal and test meal-stimulated gastrin concentrations, (2) basal and pentagastrin-stimulated gastric acid outputs, and (3) endoscopic examinations were studied. Also studied were the morphological and functional differences of the gastrointestinal tract between UD and HD patients. HD patients had lower gastric acid outputs and higher circulating gastrin levels in the fasting state. After a test meal, the peak increment of serum gastrin in UD and HD patients occurred 30 and 60 min later, respectively, and the response was prolonged in each group. Endoscopic findings showed that the incidence of abnormalities in each group was very similar, that is, the most predominant lesions in each group were hemorrhagic and atrophic gastritis. The data suggested that the response to gastrin of parietal cell and the defensive mechanism of gastrointestinal mucosa in HD patients may be impaired.

Pharmacologic Intervention to Prevent Hemodialysis Vascular Access Thrombosis

“…Because the hemodialysis population has an inherent risk of gastrointestinal bleeding [26][27][28][29] and even small doses of aspirin have been associated with significant bleeding [30,31] and increased mortality [32], we began to investigate the use of eicosapentanoic acid (EPA). EPA has been shown to be a competitive inhibiter of cyclooxygenase in normal subjects [33] and was known to reduce platelet aggregation in hemodialysis patients [34] (fig.…”

Efficacy of an intravenous proton pump inhibitor after endoscopic therapy with epinephrine injection for peptic ulcer bleeding in patients with uraemia: a case‐control study

“…However, gastric secretion in uraemic patients compared to normal controls remains controversial. Hyper‐, 12 hypo‐ 13 and normal secretions have been reported 14 . Unfortunately, these studies have small sample sizes.…”

Gastroduodenal Abnormalities in Uremia

“…Although earlier reports implicated elevated gastrin levels as a cause of increased acid output and peptic ulceration these observations have not been substantiated. In fact most studies have shown either little or no direct correlation (4) or an inverse correlation between gastrin levels and acid production (9)(10)(11). This would suggest that the hypergastrinemia associated with uremia may in fact be partially due to reduced acid production (9, 10).…”

“…In contrast, the concentration of G17, which is six times more potent than G34, is not increased. In addition, resistance to pentagastrin stimulation has been reported in patients with chronic renal failure in the absence of atrophic gastritis, (8,9) suggesting an impaired parietal cell response. Thus evidently several factors are operative in the genesis of the abnormal gastric acid secretion in chronic renal failure.…”