Vol.13, No 2, 2006 pp. 84 - 89
UC 616.3:616.61-78
ENDOSCOPIC FINDINGS IN THE PROXIMAL PART OF THE DIGESTIVE TRACT IN
PATIENTS WITH CHRONIC RENAL FAILURE UNDERGOING CHRONIC DIALYSIS PROGRAM
Suzana Raičević Sibinović1, Aleksandar Nagorni1, Radomir Raičević 2, Vesna Brzački1, Miroslav Stojanović3
1Clinic of Gastroenterology and Hepatology, Clinical Centre Niš, Serbia
2Clinic of Nephrology and Chemodialysis, Clinical Centre Niš, Serbia
3Clinic of Surgery, Clinical Centre Niš, Serbia
 E-mail: suzasr@yahoo.com
Summary. A prospective study included 30 patients with chronic renal insufficiency undergoing chronic chemodialysis, with or without digestive problems, who underwent proximal endoscopy for pretransplantation balance in the period 1998-2000. The study included patients admitted to the Institute of Nephrology and Chemodialysis of the Clinical Centre in Nis and Nephrology Clinic of the Clinical Centre of Serbia, Belgrade. The control group was composed of 21 patients with no chronic renal insufficiency treated and examined at Gastroenterology and Hepatology Clinic of the Clinical Centre in Nis who underwent proximal endoscopy. The patients were randomly selected. By proximal endoscopy performed in patients undergoing chronic dialysis, the following pathological changes were confirmed: erosions in 9 (30%), angiodysplasias in 2 (6.67%), ventricular ulcers in 1 (3.33%), duodenal ulcers in 1 (3.33%), ventricular polyps in 1 (3.33%), and a regular finding was established in 16 (53.34%) patients. External factors contribute to gastrointestinal changes: moderate quantities of alcohol consumption, smoking cigarettes, various drugs intake, and non-observance of dietetic regime. These risk factors also contribute to deciding on the performance of proximal endoscopy. The presence of the subjective problems with the digestive tract, along with the objective finding in the patients on chemodialysis are indications for proximal endoscopy aimed at prevention, and early detection of changes in the digestive tract. According to our investigation, the indications for proximal endoscopy in patients undergoing chronic hemodialysis are: patients on dialysis for 0-2 years, frequent digestive problems but not closely associated with uremic toxicity, acute gastrointestinal symptomatology (stomach aches, hematemesis, melena...etc), pretransplantation balance and patients with chronic systemic disease that receive immunosuppressive therapy for 6 months.
Key words: Endoscopic changes, chemodialysis, proximal endoscopy
ENDOSKOPSKI NALAZ PROMENA SLUZOKOŽE PROKSIMALNOG DELA DIGESTIVNOG TRAKTA U 
BOLESNIKA SA HRONIČNOM BUBREŽNOM INSUFICIJENCIJOM NA HRONIČNOM PROGRAMU HEMODIJALIZE
Kratak sadržaj: Prospektivnom studijom je obuhvaćeno 30 bolesnika sa hroničnom bubrežnom insuficijencijom na hroničnom programu hemodijalize, sa ili bez digestivnih tegoba kod kojih je rađena proksimalna endoskopija u cilju pretransplantacionog bilansa u periodu od 1998. do 2000. godine. Studija je obuhvatila pacijente Instituta za nefrologiju i hemodijalizu Kliničkog centra u Nišu i pacijente Klinike za nefrologiju Kliničkog centra Srbije u Beogradu. Kontrolnu grupu čini 21 bolesnik bez hronične bubrežne insuficijencije koji su lečeni i ispitivani na Klinici za gastroenterologiju i hepatologiju Kliničkog centra Niš, kod kojih je rađena proksimalna endoskopija. Bolesnici su odabrani metodom slučajnog izbora. Proksimalnom endoskopijom u bolesnika na hroničnom programu hemodijalize verifikovali smo sledeće patološke promene: erozije u 9 (30%), angiodisplazije u 2 (6,67%), ulkus ventrikuli u 1 (3,33%), ulkus b. duodeni u 1 (3,33%), polipus ventrikuli u 1 (3,33%) i uredan nalaz u 16 bolesnika (53,34%). Spoljašnji faktori doprinose gastrointestinalnim promenama: konzumiranje umerene količine alkohola, pušenje cigareta, korišćenje raznih lekova, i nepridržavanje higijeno-dijetetskog režima. Ovi faktori rizika takođe doprinose u odlučivanju za primenu proksimalne endoskopije. Prisustvo subjektivnih tegoba od strane digestivnog trakta uz objektivan nalaz bolesnika na hroničnom programu hemodijalize čine indikaciju za proksimalnu endoskopiju a u cilju prevencije i ranog otkrivanja promena na digestivnom traktu.Indikacije za proksimalnu endoskopiju bolesnika na hroničnom programu hemodijalize prema našim istraživanjima su:bolesnici u prvoj i drugoj godini dijaliziranja, učestale digestivne tegobe, a koje nisu u užoj vezi sa uremičkom intoksikacijom, akutna gastrointestinalna simptomatologija (bolovi u trbuhu, hematemeza, melena i dr.), pretransplantacioni bilans, i bolesnici sa hroničnim sistemskim oboljenjima, a primaju imunosupresivnu terapiju duže od 6 meseci.
Ključne reči:  endoskopske promene, hemodijaliza, proksimalna endoskopija