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      Helicobacter pylori Infection in Dialysis Patients: A Meta-Analysis

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          Abstract

          Background. Infection with Helicobacter pylori contributes to the etiopathogenesis of various extragastrointestinal conditions, yet its etiological association with either symptomatic or asymptomatic dialysis patients remains inconclusive. Methods. Two researchers working independently conducted a literature search of the online databases PubMed, EMBase, ScienceDirect, and Cochrane Central Register of Controlled Trials to identify relevant articles to the end of 2012. Case-control and cross-sectional studies that met the inclusion criteria were included. Results. Fifteen studies involving 1237 dialysis patients and 1568 controls with normal renal function were included. Compared with normal controls, dialysis patients overall were associated with a relatively lower risk of H. pylori infection though not statistically significant. A significant inverse association was found between H. pylori prevalence and duration of treatments in those who were dialyzed >4 years (odds ratio 0.28; 95% confidence interval 0.22–0.36, P < 0.00001). No relationship between H. pylori status and duration of dialysis was observed in CRF patients. There were no significant differences in endoscopic features between patients and controls. Conclusions. Our meta-analysis found no evidence of a significant association between infection with H. pylori and dialysis overall, whereas long-term treatments of more than four years had a significant protective effect.

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          Most cited references64

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          Effect of interleukin 1 polymorphisms on gastric mucosal interleukin 1beta production in Helicobacter pylori infection.

          Although epidemiological studies suggest that interleukin (IL)-1 genetic polymorphisms are involved in Helicobacter pylori-related gastric carcinogenesis, the data are conflicting regarding the effects of these polymorphisms on IL-1beta production. IL-1B-511 polymorphism was genotyped by polymerase chain reaction (PCR)-restriction fragment length polymorphism, and IL-1RN variable number of tandem repeats was determined by PCR. Mucosal IL-1beta levels were measured by enzyme-linked immunosorbent assay. To determine which factors influence mucosal IL-1beta levels, gastric inflammation, and atrophy, multiple regression analyses were performed. We studied 117 H. pylori-infected Japanese patients. Carriers of the IL-1B-511T/T genotype or IL-1RN*2 allele had higher mucosal IL-1beta levels than noncarriers (partial regression coefficient [PRC] +/- SE), TT versus CC: 37.6 +/- 6 [antrum] and 32.1 +/- 6 [corpus] pg/mg protein (P < 0.001 for each), *1/*2 versus *1/*1: 24 +/- 8 [antrum] (P <0.01) and 36.5 +/- 7 [corpus] (P <0.001). Simultaneous carriers of IL-1B-511T/T genotype and IL-1RN*2 allele had the highest IL-1beta levels (82.9 +/- 12 [antrum] and 87.2 +/- 11 [corpus]) and showed a synergistic effect between 2 loci. The *1/*2 carriers were closely related to atrophy (PRC +/- SE; 0.87 +/- 0.4 [antrum] and 0.93 +/- 0.4 [corpus], P < 0.05), whereas being a carrier of the -511T/T genotype was related to severe gastric inflammation. IL-1 genetic polymorphisms influenced H. pylori-related gastric mucosal IL-1beta levels and were related to gastric inflammation and atrophy, factors thought to be important in gastric carcinogenesis.
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            Maintenance dialysis population dynamics: current trends and long-term implications.

            Despite a general recognition that treatment of end-stage renal disease (ESRD) has become a large-scale undertaking, the size of the treated population and the associated costs are not well quantified. This report combines data available from a variety of sources and places the current (midyear 2001) estimated global maintenance dialysis population at just over 1.1 million patients. The size of this population has been expanding at a rate of 7% per year. Total therapy cost per patient per year in the United States is approximately 66,000 dollars. Assuming that this figure is a reasonable global average, the annual worldwide cost of maintenance ESRD therapy in the year 2001, excluding renal transplantation, will be between 70 and 75 billion US dollars. If current trends in ESRD prevalence continue, as seems probable, the ESRD population will exceed 2 million patients by the year 2010. The care of this group represents a major societal commitment: the aggregate cost of treating ESRD during the coming decade will exceed 1 trillion dollars, a thought-provoking sum by any economic metric.
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              Prevalence of Helicobacter pylori infection in long-term hemodialysis patients.

              Patients on hemodialysis often have gastrointestinal complications; however, it is unclear if Helicobacter pylori infection is present in these patients. Here we determined the prevalence of H. pylori infection in 539 Japanese hemodialysis patients by measuring serum anti-H. pylori IgG antibodies. Endoscopy was performed on 299 of these patients and the results were compared to 400 patients with normal renal function who had also undergone endoscopy and sero-testing. A second cohort of 478 dialysis patients, within the original group, was checked serologically for H. pylori infection three times over a four-year observation period. The prevalence of infection in these patients was significantly lower than in those patients with normal renal function, irrespective of the clinical outcomes. The prevalence of H. pylori infection significantly decreased as the duration of dialysis increased, particularly within the first four years following initiation of dialysis. About one-third of patients on dialysis for less than four years became serologically negative for H. pylori infection within this observation period. Our study suggests that although long-term dialysis patients have low prevalence of H. pylori, they still have significant gastroduodenal diseases, such as peptic ulcers, that require endoscopic follow-up.
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                Author and article information

                Journal
                Gastroenterol Res Pract
                Gastroenterol Res Pract
                GRP
                Gastroenterology Research and Practice
                Hindawi Publishing Corporation
                1687-6121
                1687-630X
                2013
                7 November 2013
                : 2013
                : 785892
                Affiliations
                1Department of Gastroenterology, First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China
                2First Clinical Medical College of Nanjing Medical University, Nanjing 210029, China
                Author notes

                Academic Editor: Khean Lee Goh

                Author information
                http://orcid.org/0000-0001-5450-558X
                Article
                10.1155/2013/785892
                3838798
                24307895
                0800d9a2-a687-4123-873e-98e90986adff
                Copyright © 2013 Min Gu et al.

                This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 10 July 2013
                : 5 September 2013
                : 19 September 2013
                Funding
                Funded by: http://dx.doi.org/10.13039/501100001809 National Natural Science Foundation of China
                Award ID: 81072032
                Funded by: http://dx.doi.org/10.13039/501100001809 National Natural Science Foundation of China
                Award ID: 81270476
                Categories
                Research Article

                Gastroenterology & Hepatology
                Gastroenterology & Hepatology

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