Gastroesophageal Reflux Disease in Chronic Renal Failure Patients

Abstract

Gastroesophageal reflux disease (GERD) is one of acid-related gastrointestinal disorders, because GERD develops when excessively acidic gastric contents reflux into the esophagus. The condition is believed mainly to be due to an increase in the number of transient LES relaxations. Other major mechanisms include decreased clearance of esophageal contents and reflux owing to impaired peristalsis, decreased gastric emptying with resultant reflux into the esophagus, and increased gastric acid production with a resultant increase in the potency of the reflux. Chronic renal failure (CRF) is associated with an increased incidence of acid-related gastrointestinal disorders (1-3). Therefore we can predict high morbidity of GERD in CRF patients, but the association between GERD and CRF remains unclear. In our study (4) by questionnaire for the diagnosis of reflux disease (QUEST) produced by Carlsson et al. (5), the prevalence of GERD was 24.2% in the 418 stable hemodialysis (HD) patients who did not undergo endoscopic examination. Compared to the reported prevalence of GERD in 6010 Japanese adults (16.3%) (6), the prevalence of GERD in CRF patients who underwent HD (24.2%) was increased. In the gastroendoscopic findings of the 156 CRF patients who underwent endoscopic examination, the prevalence of GERD was 34.0%. Especially, in symptomatic cases, the prevalence of GERD was 44.0% (7). Although we are now aware of the increasing prevalence of symptomatic GERD in HD patients, little is known about the gastroendoscopic findings and the prevalence of endoscopical GERD in CRF patients. In this chapter, I would like to explain about GERD in CRF patients.