Published online Apr 21, 2018. doi: 10.3748/wjg.v24.i15.1591
Peer-review started: February 23, 2018
First decision: March 15, 2018
Revised: March 18, 2018
Accepted: March 25, 2018
Article in press: March 25, 2018
Published online: April 21, 2018
Chronic kidney disease (CKD) patients receiving hemodialysis (HD) often develop gastrointestinal abnormalities over their long treatment period. In general, prognosis in such patients is poor due to the development of protein-energy wasting (PEW). Therefore, it is important to clarify the etiology of PEW and to establish better strategies to deal with this condition. Chronic Helicobacter pylori (H. pylori) infection in the gastric mucosa has a close association with not only the development of peptic ulcer disease and gastric cancer, but is also associated with abnormal plasma and gastric mucosal ghrelin levels that are seen in malnutrition. It is unclear whether H. pylori infection of the gastric mucosa is directly associated with prognosis in HD patients by affecting ghrelin levels. Recent studies show that the prevalence of H. pylori infection in HD patients is significantly lower than in subjects with normal renal function. In the natural history of H. pylori infection in HD patients, the prevalence of infection decreases as the length of time on HD increases. The severity of gastric mucosal atrophy has been suggested as the major determinant of ghrelin levels in these patients, and eradication therapy of H. pylori improves nutritional status by increasing serum cholinesterase and cholesterol levels, especially in patients with mild-to-moderate gastric mucosal atrophy. Prompt H. pylori eradication to inhibit the progress of gastric atrophy may be required to prevent this decrease in ghrelin levels and subsequent PEW and improve the prognosis of HD patients by improving their nutritional status.
Core tip: Hemodialysis (HD) patients have a poor prognosis related in part to protein-energy wasting (PEW), associated with low levels of ghrelin. The severity of gastric mucosal atrophy has been suggested as the major determinant of ghrelin levels. Eradication of Helicobacter pylori (H. pylori) improves nutritional status, with serum cholinesterase and cholesterol levels stimulated by rising ghrelin levels and appetite, especially in H. pylori infection-positive patients with severe gastric mucosal atrophy. Although infection rates of H. pylori have been decreasing in HD patients, it would be preferable to eradicate H. pylori promptly before progression of gastric atrophy for prevention of gastric cancer and PEW.