Brief Article
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World J Gastroenterol. Nov 21, 2013; 19(43): 7719-7725
Published online Nov 21, 2013. doi: 10.3748/wjg.v19.i43.7719
Characteristics of nonvariceal upper gastrointestinal hemorrhage in patients with chronic kidney disease
Chang Seok Bang, Yong Seop Lee, Yun Hyeong Lee, Hotaik Sung, Hong Jun Park, Hyun Soo Kim, Jin Bong Kim, Gwang Ho Baik, Yeon Soo Kim, Jai Hoon Yoon, Dong Joon Kim, Ki Tae Suk
Chang Seok Bang, Yong Seop Lee, Yun Hyeong Lee, Jin Bong Kim, Gwang Ho Baik, Yeon Soo Kim, Jai Hoon Yoon, Dong Joon Kim, Ki Tae Suk, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon 200-704, South Korea
Hotaik Sung, Department of Biology, Stanford University, Stanford, CA 94305, United States
Hong Jun Park, Hyun Soo Kim, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju 220-786, South Korea
Author contributions: Suk KT and Bang CS designed research; Bang CS, Lee YS, Lee YH, Kim JB, Baik GH, Kim YS and Yoon JH performed research; Sung H, Park HJ, Kim HS and Kim DJ contributed new reagent/analytic tools; Bang CS and Suk KT analyzed data; and Bang CS wrote the paper.
Supported by The Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (NRF-2010-0021482) to Suk KT
Correspondence to: Ki Tae Suk, MD, PhD, Department of Internal Medicine, Hallym University College of Medicine, Kyo-dong, Chuncheon 200-704, South Korea. ktsuk@hallym.ac.kr
Telephone: +82-33-240-5526 Fax: +82-33-241-8064
Received: July 23, 2013
Revised: September 4, 2013
Accepted: September 15, 2013
Published online: November 21, 2013
Processing time: 147 Days and 14.7 Hours
Abstract

AIM: To evaluate the clinical characteristics of nonvariceal upper gastrointestinal hemorrhage (NGIH) in patients with chronic kidney disease (CKD).

METHODS: From 2003 to 2010, a total of 72 CKD patients (male n = 52, 72.2%; female n = 20, 27.8%) who had undergone endoscopic treatments for NGIH were retrospectively identified. Clinical findings, endoscopic features, prognosis, rebleeding risk factors, and mortality-related factors were evaluated. The characteristics of the patients and rebleeding-related data were recorded for the following variables: gender, age, alcohol use and smoking history, past hemorrhage history, endoscopic findings (the cause, location, and size of the hemorrhage and the hemorrhagic state), therapeutic options for endoscopy, endoscopist experience, clinical outcomes, and mortality.

RESULTS: The average size of the hemorrhagic site was 13.7 ± 10.2 mm, and the most common hemorrhagic site in the stomach was the antrum (n = 21, 43.8%). The most frequent method of hemostasis was combination therapy (n = 32, 44.4%). The incidence of rebleeding was 37.5% (n = 27), and 16.7% (n = 12) of patients expired due to hemorrhage. In a multivariate analysis of the risk factors for rebleeding, alcoholism (OR = 11.19, P = 0.02), the experience of endoscopists (OR = 0.56, P = 0.03), and combination endoscopic therapy (OR = 0.06, P = 0.01) compared with monotherapy were significantly related to rebleeding after endoscopic therapy. In a risk analysis of mortality after endoscopic therapy, only rebleeding was related to mortality (OR = 7.1, P = 0.02).

CONCLUSION: Intensive combined endoscopic treatments by experienced endoscopists are necessary for the treatment of NGIH in patients with CKD, especially when a patient is an alcoholic.

Keywords: Chronic kidney diseases, Gastrointestinal hemorrhage, Endoscopy, Peptic ulcer, Alcoholics

Core tip: Patients with chronic kidney disease (CKD) have increased hemorrhagic complications, including nonvariceal upper gastrointestinal hemorrhage (NGIH). These individuals also have a higher risk of rebleeding than patients without renal dysfunction. Initial intensive combined endoscopic treatments by experienced endoscopists are necessary for the treatment of NGIH in patients with CKD, especially when a patient is an alcoholic. Factors of the consumption of alcohol, endoscopic monotherapy, and endoscopists’ lack of experience are associated with rebleeding, which is the most important factor for the prediction of mortality in CKD patients with NGIH.