Upper Gastrointestinal Bleeding in Patients with Chronic Renal Failure

Endoscopy to evaluate upper gastrointestinal bleeding was done for 482 patients over a 42-month period. Fifty-nine patients (12%) had chronic renal failure and upper gastrointestinal bleeding; the remaining 423 did not have renal failure. Angiodysplasia of the stomach or duodenum was the most frequent source of bleeding in patients with renal failure. Angiodysplasia (p < 0.001) and erosive esophagitis (p < 0.01) were significantly commoner causes of bleeding in the renal failure population than in the group without renal failure. Recurrent bleeding was also more frequent in patients with renal failure (25%) than in the other patients (11%). Angiodysplasia was the most frequent source of recurrent bleeding in patients with renal failure (53%) whereas peptic lesions were the most likely sources in those without renal failure (51%). These data show that the differential diagnoses of first and subsequent upper gastrointestinal bleeding sites differ for patients with and without chronic renal failure. GASTROINTESTINAL BLEEDING as a complication in ad-vanced renal disease is frequently reported (1-10). In the renal transplant population, gastrointestinal bleeding has been cited as the commonest intra-abdominal complica-tion (7) and accounted for 20 % of the transplant deaths in one series (5). Although the suggested increased inci-dence of peptic ulcer disease in the chronic renal failure population (11) may implicate ulcers as the cause of up-per gastrointestinal bleeding, the source of bleeding has been primarily determined by barium radiologic evalua-tion (1-10) without the benefit of the greater diagnostic accuracy associated with endoscopy (12, 13). The diag-nostic accuracy of endoscopy may be even more pro-nounced when the bleeding is from a small vascular lesion, such as angiodysplasia. These lesions have been reported in patients undergoing chronic hemodialysi