PREVALANCE, ENDOSCOPIC AND HISTOPATHOLOGICAL FEATURES OF HELICOBACTER PYLORI (H.PYLORI) INFECTION IN CHRONIC KIDNEY DISEASE (CKD) / END STAGE RENAL DISEASE (ESRD) VERSUS NORMAL POPULATION AT A TERTIARY CARE CENTER IN NORTH INDIA: A CASE CONTROL HOSPITAL BASED STUDY

Mohd. Tahir Ganaye 1 , * Sheikh Jan M. 2 , Mohammad Altaf Ganaye 3 , Samiera Hassan 4 and Bilal Ahmed 5 . 1. Registrar Department of Medicine SKIMS Medical college, Srinagar J&K India. 2. Registrar Postgraduate Department of Medicine Government Medical College, Srinagar J&K India. 3. Intern Department of Medicine SKIMS medical college, Srinagar J & K India. 4. Medical Officer, Department of Social and Preventive Medicine Government Medical College, Srinagar J&K India. 5. Postgraduate scholar Department of Medicine Government Medical College, Srinagar J&K India. ...................................................................................................................... Manuscript Info Abstract ......................... ........................................................................ Manuscript History


ISSN: 2320-5407
Int. J. Adv. Res. 4 (11), 1902-1907 1903 Introduction:-Helicobacter Pylori (H. pylori) is a gram negative spiral flagellate bacillus that resides usually in the gastric mucosa and can cause chronic active gastritis, peptic ulcer disease (1) . In addition, chronic H. Pylori infection has close associations with gastric hyper-plastic polyps, gastric adenoma, gastric cancer, and gastric mucosa associated lymphoid tissue lymphoma (2,3,4,5,6) . Extra gastro intestinal disorders including chronic idiopathic utricaria, iron deficiency anemia and idiopathic thrombocytopenic purpura (ITP) are also related to H. pylori infection. (7,8,9) H. pylori infection is the most common chronic bacterial infection in humans. Estimates indicate that approximately 60% of the world population is colonized with this agent. (10) H. pylori is regarded as an alternating agent, capable to both directly cause a local inflammatory reaction in the gastric and duodenal mucous membranes, and indirectly influence upon the processes of systemic inflammation by way of its effect upon the biochemical components of metabolism (11) .With underlying H.Pylori infection, apart from direct damage of the stomach, there occurs an abatement of the immune protective properties of the body and a multitude of systemic effects develop that cause adequate reactions on the part of other organs and systems, one of them being the urinary system. There is an evidence of a close interrelation between the development of erosive ulcerous lesions of the gastro duodenal zone and CKD progression. It is necessary to note that the progression of both pathologic processes is mutually dependent. On the one hand, H. pylori infection causes a number of systemic effects (an activation of LPO, proinflammatory cytokines, apoptosis; the secretion of biologically active substances that result in an enhancement of ischemia, tissue hypoxia, of affected organs and an activation of the thrombocytic component of homeostasis) that pathologically affect the kidneys and add to CKD progression. On the other hand, with kidney disease, especially with reduced renal function, COX-1 activation processes also reduce, thus leading to a decrease of the production of prostaglandins which are essential for sustaining both local and systemic hemodynamic in health and, in particular, they take part in the stomach protection from the factors of aggression (an enhancement of the mucus secretion, bicarbonate excretion, etc.The epidemiological data concerning H. pylori infection in ESRD patients are controversial. The reported frequency of anti H. pylori antibody in patients with renal failure ranges from 21-64 % (12,13,14) . These conflicting results may be related to various factors including the methods of detecting H. pylori infection, the size of the study population, the local prevalence of the organism in the general population, and the various features of the study population. Several studies of the epidemiological features of H. pylori infection have revealed similar findings in end stage renal disease (ESRD) (10) . However, higher or lower prevalence rates of H pylori infection in ESRD patients than the general population has been reported by many other investigators (15) . There are different explanations for the variable prevalence; Some investigators focused on the higher concentration of urea in the gastric juice of renal failure patients raising the local gastric pH and providing abundant substrate for H. pylori (16) .Some investigators concluded that the higher levels of urea in the mucus of stomach in ESRD patients may result in a lower prevalence of H. pylori colonization in these patients (17) . Furthermore, fluctuations in the gastric blood supply, low gastric motility, and hypo as well as hyperchlohydria have also been proposed for the higher prevalence of H. pylori infection in uremic patients (18) . Leffeld et al (14), Luzza et al (19) , Fabrizi et al (10) and Hosseini et al (20) , found no difference of prevalence of H. pylori infection between patients on Hemodialysis (HD) and healthy controls.
Aims and objectives:- To study the prevalence of H.Pylori infection in ESRD patients.  Endoscopic (EGD) and pathological findings in ESRD patients.  Compare the prevalence of H.Pylori infection, endoscopic and pathological findings between patients of CKD/ESRD and normal patients with GI symptoms.

Materials and methods:-
The study was conducted in the Department of Nephrology, Gastroenterology and Pathology, Sheri-Kashmir Institute of Medical Sciences (J & K India), over period of two years from October 2012 to November 2014.This study was cleared by Ethical committee as a Case-control study, total of 130 patients were enrolled in this study. Seventy patients of CKD/ESRD with Gastrointestinal symptoms were taken as Cases, Fifty (50) patients with normal kidney function and dyspeptic symptoms were taken as controls. All patients (cases and controls) underwent Esophagogastrodudenoscopy (EGD).EGD findings were noted and two antral biopsies were taken one for Rapid Urease test and another for Histopathological examination (HPE).

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Inclusion criteria:- All diagnosed cases of CKD/ESRD with upper gastrointestinal tract symptoms like GERD, dyspepsia, belching and APD.
In a study Conducted by Shen-Shong Chang, Hsiao-Yun Hu etal (29); stratified the one million study population according to CKD or ESRD. Our study the prevalence of H.Pylori in CKD/ESRD patients was less than the controls but was not statistically significant (p-value=>0.05); reason could be the very less size of our Cohort.

Conclusion:-
The prevalence of H.pylori infection, Endoscopic and pathological findings are same among patients of CKD and Normal population with GI Symptoms with antral gastritis as most common finding on Endoscopy. Chronic active gastritis as most common Histopathological diagnosis. Bibliography:-