1. Introduction
2. Is the prevalence of HP infection low in hemodialysis patients?
It is often reported that the prevalence of
3. Are duration of hemodialysis and prevalence of HP infection inversely correlated?
How are duration of hemodialysis and prevalence of
4. Is there variation in HP infection rates among different countries?
The gastricmucosa of approximately 50% of the world’s populationis infected with
There is variation in
5. Why does the hemodialysis procedure reduce the prevalence of HP infection?
One reason is eradication of
6. What are the harmful effects of a decreased prevalence of HP infection on hemodialysis patients?
In general,
Prophylactic administration of anti-acid secretory drugs, such as proton pump inhibitors (PPI), is recommended. While long-term hemodialysis is reported to carry a high risk for reflux esophagitis [32-34], this may also be attributable to suppressedgastric acid secretion due to a decrease in
7. Is HP eradication necessary for hemodialysis patients?
While the previous section described the harmful effects of a reduced prevalence of
8. How is HP eradication best achieved in hemodialysis patients?
According to recent reports, the major regimen is a combination of a PPI selected from among omeprazole, lansoprazole, and esomeprazole and 2 antibiotics selected from among clarithromycin, amoxicillin, and metronidazole, which are administered for 1 or 2 weeks [1, 6, 36-40]. Although the eradication rate fluctuates slightly from 72.7 to 96.0%, it averages around 90%. There seems to be no substantial difference in comparison with the eradication rate of
9. What are the precautions for HP eradication therapy in hemodialysis patients?
Caution should be considered in performing eradication therapy for hemodialysis patients to avoidexcessive doses of drugs. Administration of low doses results in high blood levels. However, hemodialysis removes both PPI and antibiotics, lowering their blood levels. In consideration of this fact, without adjustment of the therapy by administering the drugs after the hemodialysis session on the day of hemodialysis, the eradication rate of
Moreover, hemodialysis patients often receive oral antibiotics, and the duration of circulation of these antibiotics in the body is prolonged due to delayed metabolism. Thus, it seems that
10. Conclusion
This chapter has described
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