title: Inflammation of the gastric remnant after gastrectomy: mucosal erythema is associated with bile reflux and inflammatory cellular infiltration is associated with Helicobacter pylori infection.
abstract: BACKGROUND
  Controversy exists concerning the role of bile reflux and Helicobacter pylori ( H. pylori) infection in the development of inflammation of the gastric remnant after gastrectomy. This study was designed to investigate association of bile reflux and H. pylori infection or both with inflammatory changes in the gastric remnant.
  
  
  METHODS
  A questionnaire on GI symptoms was returned by 200 gastrectomy patients, and 24-h bilirubin monitoring in the gastric remnant was performed on 55 patients with Bilitec 2000. Upper GI endoscopy evaluated reflux gastritis in the gastric remnant, and the presence of H. pylori infection and chronic, active inflammatory cellular infiltration in the biopsy specimens were examined microscopically with the updated Sydney system.
  
  
  RESULTS
  No difference in the incidence of GI symptoms was observed among individual gastrectomy patients. Bile reflux was lower in patients who had undergone a gastrectomy with jejunal interposition, a pylorus-preserving gastrectomy, and a gastrectomy with Roux-Y anastomosis than those who had undergone a Billroth-II (B-II) anastomosis ( P < 0.05). Endoscopy showed positive correlation between mucosal erythema and bile reflux ( P < 0.001). No correlation was observed between the mucosal erythema and chronic and active inflammatory cellular infiltration. Infection of H. pylori correlated with chronic and active inflammatory cellular infiltration ( P < 0.001). Bile reflux did not correlate with the severity of chronic and active inflammatory cellular infiltration or H. pylori infection.
  
  
  CONCLUSIONS
  Bile reflux into the gastric remnant was observed by Bilitec 2000. Mucosal erythema and chronic, active inflammatory cell infiltration in the gastric remnant after gastrectomy may be caused by bile reflux or H. pylori infection, respectively.
authors.affiliation: Surgery for Organ Function and Biological Regulation (Department of Surgery I), Nippon Medical School, Tokyo, Japan.
authors.forename: Youngho
authors.initials: Y
authors.lastname: Lee
authors.forename: Akira
authors.initials: A
authors.lastname: Tokunaga
authors.forename: Takashi
authors.initials: T
authors.lastname: Tajiri
authors.forename: Gotaro
authors.initials: G
authors.lastname: Masuda
authors.forename: Takeshi
authors.initials: T
authors.lastname: Okuda
authors.forename: Itsuo
authors.initials: I
authors.lastname: Fujita
authors.forename: Teruo
authors.initials: T
authors.lastname: Kiyama
authors.forename: Toshiro
authors.initials: T
authors.lastname: Yoshiyuki
authors.forename: Shunji
authors.initials: S
authors.lastname: Kato
authors.forename: Norio
authors.initials: N
authors.lastname: Matsukura
authors.forename: Nobutaka
authors.initials: N
authors.lastname: Yamada
mesh_terms: D001655:Bile Reflux / Q000150:complications* / Q000175:diagnosis; D001663:Bilirubin / Q000032:analysis; D016099:Endoscopy, Gastrointestinal; D004890:Erythema / Q000209:etiology*; D005260:Female; D005743:Gastrectomy; D005753:Gastric Mucosa / Q000382:microbiology / Q000473:pathology*; D018530:Gastric Stump / Q000473:pathology*; D016481:Helicobacter Infections / Q000150:complications* / Q000473:pathology; D016480:Helicobacter pylori; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011788:Quality of Life; D013053:Spectrophotometry
chemical_list: D001663:Bilirubin