Helicobacter pylori infection after partial gastrectomy for peptic ulcer and its role in relapsing disease.
OBJECTIVE
To elucidate the role of Helicobacter pylori in relapsing disease after partial gastrectomy for peptic ulcer.


METHODS
Retrospective study of gastroscopies between January 1985 and February 1988.


METHODS
Department of Surgery, Helsinki University Central Hospital, Finland.


METHODS
One hundred and fifty-five patients, who had undergone partial gastrectomy for peptic ulcer disease.


METHODS
Correlation between clinical and laboratory data, macroscopic findings at gastroscopy and histopathology.


RESULTS
At gastroscopy 41 patients showed an ulcer at the site of anastomosis or in the gastric stump and two patients had a history of a previous ulcer recurrence. The median time interval between operation and relapse was 4 years. There was no correlation between ulcer recurrence, sex, age, ABO blood group or other diseases. Smokers and patients using non-steroidal anti-inflammatory drugs (NSAIDs) or alcohol had more relapses, but the difference was not significant. The recurrence rate was higher after Billroth II (BII; 34%) than after Roux-en-Y (14%; P = 0.03) or Billroth I (BI) reconstruction (24%). Giemsa staining demonstrated H. pylori in the gastric stump of 37% of the patients. H. pylori expression was related to age but unrelated to sex, ABO blood group, NSAID use, smoking or alcohol consumption. H. pylori positivity was more common (52%) after BI than after BII (28%; P = 0.04) or Roux-en-Y resection (40%). Recurrent ulcer was more often found in gastric remnants with normal mucosa (36%) than in those with H. pylori-positive gastritis (18%; P = 0.03) or H. pylori-negative gastritis (26%).


CONCLUSIONS
It seems that H. pylori infection plays a minor role in the pathogenesis of ulcer recurrence after partial gastrectomy for peptic ulcer disease. Eradication of H. pylori of the remnant stomach is therefore presumably not effective in preventing ulcer recurrence.
Leivonen
M K
MK
Peijas Hospital, Vantaa, Finland.
Haglund
C H
CH
Nordling
S F
SF
D000328:Adult; D000368:Aged; D001706:Biopsy; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects*; D005753:Gastric Mucosa / Q000382:microbiology / Q000473:pathology; D005763:Gastroenterostomy; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000209:etiology* / Q000473:pathology; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D013276:Stomach Ulcer / Q000382:microbiology* / Q000473:pathology / Q000601:surgery; D014628:Vagotomy