단일기관에서 소화성 궤양을 진단 받은 투석 환자의 Helicobacter pylori 유병률 = Prevalence of Helicobacter pylori Infection on Peptic Ulcer in Dialysis Patients in One Center

다국어 초록 (Multilingual Abstract)

Purpose: Patients with chronic renal failure tend to have an increased incidence of peptic ulcer disease. Helicobacter pylori (H. pylori) infection is generally found to be the major cause of peptic ulcer disease. There are a few studies about the association between H. pylori and peptic ulcer disease in dialysis patients. In this retrospective study, we investigated the relationship between H. pylori and peptic ulcer disease in dialysis patients.
Methods: The participants enrolled in this study were hemodialysis (HD) or peritoneal dialysis (PD) patients in the period from February 2001 to March 2010, who had been diagnosed as having a peptic ulcer. The presence of H.pylori was identified by at least one of the following: the rapid urease test, the urea breath test or histologic findings.
Results: A total of 132 patients (100 HD and 32 PD patients) were enrolled. The mean age and duration of dialysis were 56.5±14.8 years and 27.6±45.3 months, respectively. The prevalence of H. pylori- positive patients amongst those with peptic ulcer disease was 43.1% (57/132). H. pylori-positive prevalence was 48.1% (38/79) in gastric ulcer patients, and 33.3% (11/33) in duodenal ulcer patients, but this difference was not significant (p=0.21). There were no significant differences in age, causes of chronic renal failure or dialysis method between the H. pylori-positive and H. pylori-negative groups. However, the duration of dialysis was significantly longer in the H. pylori-negative group (16.6±34.1 vs. 36.0±50.8 months, p=0.01). Furthermore, as the duration of dialysis increased, the prevalence of H. pylori infection decreased (p=0.004).
Conclusion: There was little association between H. pylori and peptic ulcer disease in dialysis patients. Long-term dialysis appeared to decrease the prevalence of H. pylori infection in peptic ulcer disease.

국문 초록 (Abstract)

목 적: 만성 신부전 환자에게서 소화성 궤양의 발생 빈도가 높다. H. pylori 감염은 소화성 궤양의 발생과 재발에 결정적인 역할을 하는 것으로 알려져 있다. 그러나 투석 환자에게서는 H. pylori가 소화성 궤양에 미치는 영향에 대해서는 연구가 많지 않다. 이러한 이유로 저자들은 투석 환자에게서 소화성 궤양과 H. pylori의 연관성을 알아보고자 하였다.
방 법: 2001년 2월부터 2010년 3월까지 순천향 대학교 부천병원에서 말기 신부전으로 혈액 또는 복막투석을 받는 환자 중 소화성 궤양을 진단받은 환자를 대상으로 하였다. H. pylori 진단은 신속 요소분해요소 검사나 요소호기검사 혹은 조직 검사를 통해 한 가지 이상에서 양성이 나온 경우 H. pylori에 감염된 것으로 정의하였다.
결 과: 대상은 132명 이었고, 평균 나이는 56.5±14.8세였다. 혈액투석과 복막투석 환자가 각각 100명, 32명 이었으며, 이들의 평균 투석 기간은 27.6±45.3개월이었다. 소화성 궤양을 진단받은 환자 중 H. pylori의 양성률은 43.1% (57/132) 이었다. 위궤양 환자 중 H. pylori 양성은 48.1% (38/79)로 십이지장 궤양의 33.3% (11/33) 보다 호발하였으나 두 군간의 차이는 없었다 (p=0.21). H. pylori 양성군과 음성군 사이에는 성별과 나이, 만성 신부전의 원인 질환, 투석 방법 등은 차이가 없었으나, H. pylori 음성군에서 투석 유지 기간이 더 길었다 (16.6±34.1 vs 36.0±50.8개월, p=0.01). 투석 기간이 증가할수록 H. pylori 음성률이 증가하였다 (p=0.004).
결 론: 투석 환자들에게서 H. pylori와 소화성 궤양은 연관성이 적었으며, 투석 기간이 증가할수록 H. pylori 유병률은 더욱 감소하였다.

참고문헌 (Reference)

1 김나영, "헬리코박터 파일로리 감염의 진단 및 치료 가이드라인" 대한소화기학회 54 (54): 269-278, 2009

2 김지현, "특수한 질환에서 소화성궤양 치료의 가이드라인" 대한소화기학회 54 (54): 318-327, 2009

3 Marshall BJ, "Urea protects Helicobacter (Campylobacter) pylori from the bactericidal effect of acid" 99 : 697-702, 1990

4 Arroyo MT, "The prevalence of peptic ulcer not related to Helicobacter pylori or non-steroidal anti-inflammatory drug use is negligible in southern Europe" 9 : 249-254, 2004

5 Kim H, "The gastric juice urea and ammonia levels in patients with Campylobacter pylori" 94 : 187-191, 1990

6 Jaspersen D, "Significantly lower prevalence of Helicobacter pylori in uremic patients than in patients with normal renal function" 30 : 585-588, 1995

7 임정윤, "Seroprevalence of Helicobacter pylori in South Korea" BLACKWELL PUBLISHING 12 (12): 333-340, 2007

8 Cho GJ, "Role of Helicobacter pylori in gastro-duodenal mucosal lesions in patients with end-stage renal disease" 16 : 531-536, 1997

9 Sugimoto M, "Prevalence of Helicobacter pylori infection in long-term hemodialysis patients" 75 : 96-103, 2009

10 Kim DH, "Prevalence of Helicobacter pylori in patients with end stage renal disease" 20 : 97-102, 2000

11 Gladziwa U, "Prevalence of Helicobacter pylori in patients with chronic renal failure" 8 : 301-306, 1993

12 Chey WD, "Practice Parameters Committee of the American College of Gastroenterology: American college of gastroenterology guideline on the management of Helicobacter pylori infection" 102 : 1808-1825, 2007

13 Gladziwa U, "Pharmacokinetics and pharmacodynamics of cisapride in patients undergoing hemodialysis" 50 : 673-681, 1991

14 Nishikawa K, "Non-Helicobacter pylori and non-NSAID peptic ulcer disease in the Japanese population" 12 : 635-640, 2000

15 Moriyama T, "Helicobacter pylori status and esophagogastroduodenal mucosal lesions in patients with end-stage renal failure on maintenance hemodialysis" 45 : 515-522, 2010

16 Aguilera A, "Helicobacter pylori infection: a new cause of anorexia in peritoneal dialysis patients" 21 (21): S152-S156, 2001

17 Suerbaum S, "Helicobacter pylori infection" 347 : 1175-1186, 2002

18 Nakajima F, "Helicobacter pylori in patients receiving long-term dialysis" 22 : 468-472, 2002

19 Khedmat H, "Gastro-duodenal lesions and Helicobacter pylori infection in uremic patients and renal transplant recipients" 39 : 1003-1007, 2007

20 Fabbian F, "Esophagogastroduodenoscopy in chronic hemodialysis patients: 2-year clinical experience in a renal unit" 58 : 54-59, 2002

21 De Vecchi AF, "Epidemiology of Helicobacter pylori in dialysis patients" 15 : 178-179, 1995

22 Tang JH, "Endoscopic diagnosis of Helicobacter pylori infection by rapid urease test in bleeding peptic ulcers: a prospective case- control study" 43 : 133-139, 2009

23 Kang MJ, "Efficacy and safety of standard triple therapy of Helicobacter pylori eradication in patients with chronic kidney disease" 7 : 20-25, 2007

24 Hwang IR, "Effect of interleukin 1 polymorphisms on gastric mucosal interleukin 1 beta production in Helicobacter pylori infection" 123 : 1793-1803, 2002

25 Schoonjans R, "Dyspepsia and gastroparesis in chronic renal failure: the role of Helicobacter pylori" 57 : 201-207, 2002

26 Misra V, "Decreased sensitivity of the ultrarapid urease test for diagnosing Helicobacter pylori in patients with chronic renal failure" 31 : 44-46, 1999

27 Milito G, "Assessment of the upper gastrointestinal tract in hemodialysis patients awaiting renal transplantation" 78 : 328-331, 1983

28 Berstad A, "Antacids reduce Campylobacter pylori colonization without healing the gastritis in patients with nonulcer dyspepsia and erosive prepyloric changes" 95 : 619-624, 1988