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Hemodialysis and peritoneal lavage are now widely accepted as successful means of maintaining the lives of patients with chronic renal failure. However, little is known of the long-term complications which may be associated with either dialytic therapy or increased longevity (7). Nausea and vomiting are common with respect to the gastrointestinal tract in particular (11), and there has been a reported increase in the incidence of peptic ulceration (4, 9, 11). In an attempt to evaluate these symptoms and to more clearly define their significance, a program of serial radiologic examinations of the upper gastrointestinal tract was undertaken in patients who were undergoing long-term hemodialysis or peritoneal lavage at the Mt. Sinai Hospital of Cleveland. It is the purpose of this paper to report the radiologic appearance of the upper gastrointestinal tract in these individuals. A radiologic pattern common to many of them was observed, which appears unrelated to peptic ulceration, and may be useful in the evaluation of the uremic patient. material and methods The study group was composed of 48 patients, 23 females and 25 males. Fourteen were maintained by intermittent peritoneal lavage for periods ranging from six to twenty-four months. The method employed has been described previously (12). These patients had creatinine clearances of less than 15 cc/min. and upon initial evaluation were frankly uremic. The other 34 patients were treated with hemodialysis for periods ranging from six to thirty-four months. The Twin Coil was employed for six hours twice weekly. Creatinine clearances in these patients ranged from 0–8 cc/min. when first seen. Routine roentgen examination of the upper gastrointestinal tract was performed during the initial evaluation period for all patients, and subsequently at six-month intervals. Additional gastrointestinal examinations were performed, based on the clinical indications (bleeding, abdominal pain, and persistent vomiting). The radiologic examination included fluoroscopy, spot-filming, and radiographs in the postero-anterior, right anterior oblique, and right lateral projections. Clinical records of related gastrointestinal complaints and complications were maintained carefully during the period of treatment. Gastric analyses were performed on 7 patients, all in the hemodialysis group, before the institution of regular therapy and again after an average interval of one month on treatment. The following determinations were made on the gastric samples: (a) mean one-hour basal total acid concentration, total acid output, and volume (Table I) and (b) mean one-hour post-Histalog acid concentration, total acid output, and volume (Table II). Radiologic examination of the upper gastrointestinal tract was performed within three days of each gastric analysis. Autopsy material from 14 patients in the study group was available for review.