title: Influence of bile reflux and Helicobacter pylori infection on gastritis in the remnant gastric mucosa after distal gastrectomy.
abstract: BACKGROUND
  Two main pathogenic factors, bile reflux and Helicobacter pylori infection, have been identified in the remnant stomach, but it is still unclear which factor is important in the pathogenesis of gastritis in the remnant stomach after distal gastrectomy.
  
  
  METHODS
  In 184 patients who had had distal gastrectomy performed using the Billroth-I procedure (B-I; n-106), Billroth-II procedure (B-II; n-36), and jejunal interposition (J-I; n-42) we examined the severity of remnant gastritis endoscopically and carried out examinations for H. pylori infection and histological examination.
  
  
  RESULTS
  The endoscopic severity of remnant gastritis was grade 1 or more in 101 of the 106 B-I patients (95.3%) and in all 36 B-II patients (100%). But, of the 42 J-I patients, the grade was 0 in 33 (78.6%). The endoscopic severity of remnant gastritis was significantly milder for J-I than for B-I (P < 0.001) and B-II (P < 0.001). H. pylori infection was confirmed in 59 of the 106 B-I patients (55.6%), 21 of the 36 B-II patients (58.3%), and 32 of the 42 J-I patients (76.1%). The rate of H. pylori infection was higher for J-I patients than for B-I (P < 0.05), but not for B-II patients (P = 0.1495). The severity of chronic and active inflammatory cellular infiltration tended to be inverse proportional relation with the endoscopic severity of the remnant gastritis. Furthermore, the histological inflammation and activity scores of H. pylori-positive patients were higher than those of H. pylori-negative patients, without regard to the endoscopic grade of gastritis.
  
  
  CONCLUSIONS
  Reconstruction techniques play an important role in the prevention of bile reflux, and we found that endoscopically more severe remnant gastritis was associated with a lower rate of H. pylori infection and with a lower degree of inflammatory cellular infiltration.
authors: Arita Gastro-Intestinal Hospital, 1-2-6 Maki, Oita, 870-0924, Japan.
authors: Hisanori
authors: H
authors: Abe
authors: Kazunari
authors: K
authors: Murakami
authors: Shunzo
authors: S
authors: Satoh
authors: Ryugo
authors: R
authors: Sato
authors: Masaaki
authors: M
authors: Kodama
authors: Tsuyoshi
authors: T
authors: Arita
authors: Toshio
authors: T
authors: Fujioka
mesh_terms: D000368:Aged; D001655:Bile Reflux / Q000150:complications*; D001706:Biopsy; D002908:Chronic Disease; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy; D005753:Gastric Mucosa / Q000382:microbiology / Q000473:pathology; D005756:Gastritis / Q000209:etiology* / Q000473:pathology; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000150:complications*; D016480:Helicobacter pylori / Q000302:isolation & purification*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013274:Stomach Neoplasms / Q000601:surgery; D013276:Stomach Ulcer / Q000601:surgery