title: High frequency of ulcers, not associated with Helicobacter pylori, in the stomach in the first year after kidney transplantation.
abstract: BACKGROUND
  Although gastrointestinal (GI) symptoms are very frequent in organ transplant patients, there is a paucity of data about the endoscopic findings of kidney recipients.
  
  
  METHODS
  Two thousand one hundred and thirty-five kidney transplants were performed between 1994 and 2007. During that period, 672 gastroscopies were performed in 543 of those patients. Their mean age was 49.5 years and 56.9% were male. Immunosuppressive combinations included cyclosporine-mycophenolate-steroids, cyclosporine-steroids and tacrolimus-mycophenolate mofetil-steroids. Ninety-eight percent of the patients received acid suppression therapy.
  
  
  RESULTS
  The rate of clinically significant endoscopic findings was 84%. Macroscopic findings included inflammation in 46.7%, oesophagitis in 24.7%, ulcer in 16.9% and erosions in 14.8% of cases. Twenty-nine percent of endoscopies showed ulcer disease more frequently in the first 3 months (P=0.0014) after transplantation than later, and 45.7% of all ulcers developed in the first year. The presence of Helicobacter pylori was verified in 20.9% of cases, less than in the general, and also in the uraemic population (P<0.0001). There was no association between the presence of H. pylori and ulcers (P=0.28). Steroid pulse treatment for rejection was not associated with more ulcers (P=0.11); the use of mycophenolate mofetil increased the risk of erosions by 1.8-fold.
  
  
  CONCLUSIONS
  More than 25% of all kidney recipients required upper endoscopy in their 'post-transplant life'; the prevalence of 'positive findings' and ulcer disease was higher than in the general population (P<0.0001). The most vulnerable period is the first 3 months. Mycophenolate mofetil had an impact on GI complications, whilst the presence of H. pylori in the transplant population is not associated with the presence of ulcers.
authors.affiliation: Transplantation and Surgical Clinic, Research Group of Hungarian Academy of Sciences, Semmelweis University, Budapest, Hungary. telkesdr@gmail.com
authors.forename: Gabor
authors.initials: G
authors.lastname: Telkes
authors.forename: Antal
authors.initials: A
authors.lastname: Peter
authors.forename: Zsolt
authors.initials: Z
authors.lastname: Tulassay
authors.forename: Argiris
authors.initials: A
authors.lastname: Asderakis
mesh_terms: D005260:Female; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000453:epidemiology*; D016480:Helicobacter pylori; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D013276:Stomach Ulcer / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D013997:Time Factors