Correlation between duodenogastric reflux and remnant gastritis after distal gastrectomy.
OBJECTIVE
Many patients who undergo distal gastrectomy develop remnant gastritis. This report describes the correlation between remnant gastritis and the amount of duodenogastric reflux and looks at the relationship between Helicobacter pylori infection and duodenogastric reflux in remnant gastritis.


METHODS
Sixty-two patients who underwent curative distal gastrectomy for gastric cancer with radical lymphadenectomy were studied. The period of bile reflux (percent time) into the gastric remnant was measured with the Bilitec 2000 under standardized conditions. Remnant gastritis was semi-quantified using the neutrophil infiltration score based on the updated Sydney System, and the presence of H. pylori infection was determined 12 weeks after the surgery.


RESULTS
Overall, the correlation was not significant between the neutrophil infiltration score and the percent time (p=0.08). Similarly, the correlation was not significant in patients with H. pylori infection (p=0.30), but it was significant in patients without H. pylori infection (p=0.03).


CONCLUSIONS
Duodenogastric reflux after distal gastrectomy can cause remnant gastritis in patients without H. pylori infection. Reconstruction with biliary diversion is protective against the development of remnant gastritis.
Fukuhara
Kenichiro
K
Department of Gastroenterological Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan. fuku@eva.hi-ho.ne.jp
Osugi
Harushi
H
Takada
Nobuyasu
N
Takemura
Masashi
M
Lee
Shigeru
S
Taguchi
Shinich
S
Kaneko
Masahiro
M
Tanaka
Yoshinori
Y
Fujiwara
Yushi
Y
Nishizawa
Satoshi
S
Kinoshita
Hiroaki
H
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004383:Duodenogastric Reflux / Q000209:etiology*; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000379:methods*; D018530:Gastric Stump; D005756:Gastritis / Q000209:etiology* / Q000503:physiopathology; D016481:Helicobacter Infections / Q000150:complications; D016480:Helicobacter pylori; D006801:Humans; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D020556:Neutrophil Infiltration; D012189:Retrospective Studies; D013274:Stomach Neoplasms / Q000150:complications / Q000601:surgery*