From the Research
End-stage renal disease (ESRD) is associated with esophageal dysfunction, primarily due to uremic toxins affecting smooth muscle function and autonomic neuropathy disrupting normal esophageal motility, leading to esophageal motility disorders, gastroesophageal reflux disease (GERD), and delayed gastric emptying 1. The relationship between ESRD and esophageal dysfunction is complex, involving multiple mechanisms that contribute to the development of esophageal disorders. Key factors include:
- Uremic toxins affecting smooth muscle function
- Autonomic neuropathy disrupting normal esophageal motility
- Fluid overload and electrolyte imbalances exacerbating symptoms Management of esophageal dysfunction in ESRD patients involves both lifestyle modifications and medications, including:
- Lifestyle modifications: elevating the head of the bed, avoiding eating within 3 hours of bedtime, and limiting foods that trigger reflux
- Medications: proton pump inhibitors (PPIs) like omeprazole (20-40mg daily) or pantoprazole (40mg daily) as first-line treatments, H2 blockers such as famotidine (20mg twice daily) as alternatives, and prokinetic agents like metoclopramide (5-10mg before meals and at bedtime) for motility issues 2, 1. Regular dialysis can help improve esophageal symptoms by reducing uremic toxin levels, and careful monitoring for extrapyramidal side effects is necessary when using prokinetic agents, especially in ESRD patients 3, 4.