Factors associated with delayed arteriovenous fistula maturation in chronic kidney disease patients
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Date
2015
Authors
Huey Tean, Kok
Journal Title
Journal ISSN
Volume Title
Publisher
Pusat Pengajian Sains Perubatan, Universiti Sains Malaysia
Abstract
BACKGROUND: Northeastern peninsular state of Kelantan has an exceptionally low
prevalence of Helicobacter Pylori infection; yet receive high volume of patients referred
for Oesophago-gastroenteroscopy (OGDS) for upper gastrointestinal symptoms. CLO
test is the most commonly used initial diagnostic test, but sensitivity is widely variable
especially in the background of low prevalence. Amount of tissue biopsy and site of
gastric biopsy may be crucial in maximizing the detection rate in this region.
METHOD: 150 patients with upper gastrointestinal symptoms undergoing elective
OGDS in Hospital Universiti Sains Malaysia (HUSM) were included. Four gastric
mucosa biopsies were taken from each patient using a standard 2.8mm biopsy forcep,
at the pre-pyloric region within 3cm from pylorus, each bite adjacent to each other. One
biopsy specimen was compared with two biopsy specimens on a CLO test well, and
positive results were recorded when there was colour change at 1 hour, 3 hour, 6 hour
and 24 hour. The fourth specimen was sent for histopathological examination with
Haematoxylin & Eosin staining, followed by Warthin-Starry staining as control to
diagnose Helicobacter pylori. Data entry and analysis was done using SPSS software
version 20. Mc Nemar’s test was used to compare the overall sensitivity of CLO test and
sensitivity at each time between both groups to determine the earliest detection.
RESULTS: Overall prevalence rate of Helicobacter pylori infection was 13.3%.
Demographic pattern is consistent with previous local studies, but this study recorded a
higher prevalence rate of 10.7% among Malay ethnic patients. Presentation with black tarry stool has the highest prevalence rate of infection at 22.2%, whereas endoscopic
diagnosis of gastric ulcer has the highest prevalence rate of infection at 32%. Overall
sensitivity of both group were equal at 75% with no statistical significance. However,
speed of CLO test becoming positive was slightly higher in two biopsy group at 1 hour
and 3 hour, recording sensitivities of 37.5% and 68.8% respectively, compared to single
biopsy group with sensitivities of 25.0% and 37.5% respectively, without any statistical
significance.
CONCLUSION: This study confirmed the low prevalence of Helicobacter pylori infection
in this region but suggested that the method applied may improve the detection rate,
particularly among ethnic Malay population with low bacterial load in their gastric
mucosa. Sensitivity of CLO test is similar with either single or double biopsy specimens,
but speed of CLO test becoming positive appeared to be slightly higher with double
biopsy specimens, even though statistically not significant. Both presenting symptoms
and endoscopic diagnosis are poor indicator of Helicobacter pylori status in this region.
However, prevalence according to racial distribution is consistent with national pattern.
Description
Keywords
Renal insufficiency, Chronic