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125 ENDOSCOPIC EVALUATION OF DIALYSIS PATIENTS WITH ANEMIA OR GASTROINTESTINAL BLEEDING G Chan, J Gregor, N Chande End-stage renal disease (ESRD) patients on dialysis are often referred for endoscopic evaluation of a low or decreasing hemoglobin, or for overt GI bleeding. These patients may be prone to develop peptic ulcer disease or angiodyplasia. However, they also suffer from other hematological conditions, including ineffective erythrocyte synthesis due to low erythropoietin production and uremic platelet dysfunction, which also complicate the picture. There are few studies that evaluate the endoscopic findings of dialysis patients.
London Health Science Centre, London, Ontario
We examined a series of hemo- and peritoneal dialysis patients referred for anemia or GI bleeding. 2000 consecutive patients who underwent upper endoscopy or colonoscopy were screened, and 50 dialysis patients were identified. Of these, 26 patients were referred for assessment of anemia and/or GI bleeding.
One patient referred for anemia without overt signs of bleeding was found to have ulcerative esophagitis at upper endoscopy. All 15 patients referred for symptoms of upper GI bleeding (mainly hematemesis, coffee grounds emesis, or melena) underwent upper endoscopy. Of these, 12 had abnormal findings, including mild gastric inflammation (3), duodenal or gastric ulcer (5), ulcerative esophagitis (2), and vascular ectasia (2). Of these, 3 received endoscopic treatment, while 10 were treated with PPI and/or HP pack alone. Two patients also underwent colonoscopy which were both normal.
All 10 patients referred for symptoms of lower GI bleeding (mainly hematochezia) underwent colonoscopy; 3 of these also underwent upper endoscopy. Eight had abnormal findings at colonoscopy, including diverticulosis (2), non-bleeding benign polyp (2), ulcer (2), adenocarcinoma (1), and colitis (1). Of these, the benign polyps were not thought to be sufficient to explain the symptoms. The 3 upper endoscopies revealed 1 abnormal finding of ulcerative esophagitis.
In conclusion, upper endoscopy and colonoscopy are high yield for determining the causes of upper and lower GI bleed for ESRD patients on dialysis. However, the types of lesions found at EGD are generally treated with PPI or HP eradication, and it might be useful to use PPI therapy prophylactically in ESRD patients at high risk for upper gastrointestinal bleeding. Although colonoscopy might be difficult with bowel preparations causing fluid balance and electrolyte problems, it is a useful test for lower gastrointestinal bleed patients.