Incidence Peptic Ulcer Disease (PUD) has decreased over the past several years, so also surgeries for the condition; precisely due to the use of medications to decrease the strength of acid in stomach.
However, in a study of 10 years database extracted from the National Health Insurance Research Database in Taiwan, from 1998–2008, a group of researchers have found that the incidence of PUD has, in fact, increased among patients of Chronic Kidney Disease (CKD), particularly those who receive haemodialysis (HD).
|A benign gastric ulcer (from the antrum) of a gastrectomy specimen. (Photo credit: Wikipedia)|
They have found that in general population the incidence of PUD is between 1.1 and 2.0 per 1000 persons per year, whereas, it has increased from 13.2 to 19.8 per 1000 persons/year over that time in CKD. The incidence is 10–12 times higher than in patients without CKD.
Though CKD, itself is an independent risk factor for development of gastric or duodenal ulcer, the use of clopidogrel, aspirin, NSAIDs for other co-morbidities, and maintenance haemodialysis might be other major contributing factors.
Use of anticoagulant during HD may contribute to this risk. Hypotension during HD may occur in approximately 20–30% of HD sessions and consequent hemodynamic changes might play a role in the occurrence of PUD.
Hypotension induced splanchnic hypoperfusion may lead to gastrointestinal mucosal ischemia and development of stress ulcer-like mucosal lesions.
Further, acute illness, such as sepsis or acute myocardial infarction may lead to more frequent hypotension during HD.
The group suggests more research relating to peptic ulcer risk in the CKD population.
The original article published in the PLOS One may be accessed here.