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Abstract

We thank Cappell et al for the interest in our study. A potential for confounding was raised for the outcome of peptic ulcer rebleeding if patients with acute and transient renal insufficiency were excluded.1Cheung J. Yu A. LaBossiere J. et al.Peptic ulcer bleeding outcomes adversely affected by end-stage renal disease.Gastrointest Endosc. 2010; 71: 44-49Abstract Full Text Full Text PDF PubMed Scopus (62) Google Scholar In our study, patients who had a transient elevation in the creatinine level, which improved to <110 μmol/L by 6 months, were not excluded and were categorized as normal. If renal function did not improve by 6 months and did not require dialysis, they were categorized as having chronic kidney disease. We did exclude patients with acute renal insufficiency who required transient dialysis, to avoid confusion with patients who were chronically on dialysis. We believed a priori that the latter group was at higher risk of rebleeding. However, only 2 patients were excluded, and, therefore, their numbers were unlikely to have confounded the results.With respect to the question of location of bleeding peptic ulcers in patients with end-stage renal disease (ESRD), there was a similar distribution between gastric and duodenal lesions. Out of 50, 20 were gastric ulcers and 30 were duodenal. Pyloric channel ulcers were recorded as gastric ulcers. There was a high rate of rebleeding regardless of ulcer location among ESRD patients. Nine of 20 gastric ulcers (45%) and 10 of 30 duodenal ulcers (33%) rebled. Because of the small sample size after subgrouping, further statistical testing would not be conclusive. Future studies of peptic ulcer bleeding in ESRD patients will likely require a multiple-center study to obtain a large sample size, especially if subgroup analyses by ulcer stigmata or location are required. We thank Cappell et al for the interest in our study. A potential for confounding was raised for the outcome of peptic ulcer rebleeding if patients with acute and transient renal insufficiency were excluded.1Cheung J. Yu A. LaBossiere J. et al.Peptic ulcer bleeding outcomes adversely affected by end-stage renal disease.Gastrointest Endosc. 2010; 71: 44-49Abstract Full Text Full Text PDF PubMed Scopus (62) Google Scholar In our study, patients who had a transient elevation in the creatinine level, which improved to <110 μmol/L by 6 months, were not excluded and were categorized as normal. If renal function did not improve by 6 months and did not require dialysis, they were categorized as having chronic kidney disease. We did exclude patients with acute renal insufficiency who required transient dialysis, to avoid confusion with patients who were chronically on dialysis. We believed a priori that the latter group was at higher risk of rebleeding. However, only 2 patients were excluded, and, therefore, their numbers were unlikely to have confounded the results. With respect to the question of location of bleeding peptic ulcers in patients with end-stage renal disease (ESRD), there was a similar distribution between gastric and duodenal lesions. Out of 50, 20 were gastric ulcers and 30 were duodenal. Pyloric channel ulcers were recorded as gastric ulcers. There was a high rate of rebleeding regardless of ulcer location among ESRD patients. Nine of 20 gastric ulcers (45%) and 10 of 30 duodenal ulcers (33%) rebled. Because of the small sample size after subgrouping, further statistical testing would not be conclusive. Future studies of peptic ulcer bleeding in ESRD patients will likely require a multiple-center study to obtain a large sample size, especially if subgroup analyses by ulcer stigmata or location are required. Could a higher rebleeding rate for bleeding peptic ulcers in patients with renal failure be an artifactual finding?Gastrointestinal EndoscopyVol. 72Issue 5PreviewI commend Dr Cheung et al1 for their interesting and informative article in the January 2010 issue of Gastrointestinal Endoscopy. In this study, they compared clinical outcomes for bleeding from peptic ulcer disease in 3 patient groups: (1) endstage renal disease (ESRD) defined as hemodialysis or peritoneal dialysis for >6 months, (2) chronic kidney disease (CKD) defined as serum creatinine >110 μmol/L for >6 months, and (3) normal baseline kidney function defined as serum creatinine <110 μmol/L for >6 months. Full-Text PDF