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Helicobacter pylori (H. pylori) infection is highly prevalent in developing countries. While it seldom causes clinically important complications, it can cause complications in individuals with chronic kidney disease (CKD), particularly post-transplantation, due to the use of high doses of immunosuppressives. Furthermore, H. pylori infection can directly lead to anemia or contribute to it through gastrointestinal bleeding.
This study was conducted in the Departments of Gastroenterology and Nephrology at Bangabandhu Sheikh Mujib Medical University. It included a total of 128 prospective kidney transplant patients who underwent upper gastrointestinal (GI) endoscopy. H. pylori was detected through Rapid urease test and Histopathology.
Approximately 40% of patients were infected with H. pylori. Surprisingly, the presence of H. pylori did not appear to have a significant impact on the overall occurrence of upper gastrointestinal (GI) lesions. However, when scrutinizing individual lesions, gastritis, which was the most common lesion, was significantly higher in the H. pylori-infected group (p = 0.0016). Interestingly, the H. pylori positive patients did not seem to have notably increased dyspeptic symptoms that could have otherwise warranted any investigation.
Although the hemoglobin levels were slightly lower in H. pylori-positive patients (9.6 vs. 9.9 gram/deciliter), the difference was not significant. However, the transferrin saturation (TSAT) was significantly lower in the H. pylori group (p = 0.0183).
Another interesting observation was that patients undergoing hemodialysis had a higher rate of H. pylori infection compared to the non-dialysis group (p = 0.0074).
H. pylori infection was quite prevalent in CKD patients, especially those on hemodialysis. It did not seem to cause increased symptoms, which creates diagnostic dificulty. H. pylori infection seemed to cause increased gastritis, but did not seem to increase the overall prevalence of upper GI lesions. Future research should focus on exploring the long-term effects of H. pylori infection on CKD outcomes, while including more patients with earlier stages of CKD. The effectiveness of eradication therapies in improving hematological parameters should also be assessed. Since H. Pylori is often asymptomatic, does not always cause lesion and quite prevalent in Bangladeshi CKD population, it should be routinely checked for in this group, especially before transplantation in countries where H. pylori infection rate is high.