Spontaneous clearance of Helicobacter pylori colonization in patients with partial gastrectomy: correlates with operative procedures and duration after operation.
OBJECTIVE
For patients undergoing gastric surgery because of complications of peptic ulcers, such as bleeding or perforation in the pre-Helicobacter pylori eradication era, their infection status was not surveyed or it was neglected altogether. Previous reports have shown spontaneous clearance of H. pylori in these patients but the determining factors remain ill-defined.


METHODS
Seventy-six patients with previous partial gastrectomy for complicated peptic ulcers were enrolled prospectively. Patients with peptic ulcers but without gastrectomy were selected as a control group. Gastric biopsy specimens were obtained from each patient for histological H. pylori staining and rapid urease test on endoscopic evaluation. Spontaneous clearance of H. pylori colonization was defined when patients who were positive for H. pylori prior to operation became negative, without eradication treatment.


RESULTS
The prevalence of H. pylori colonization was significantly lower in patients with partial gastrectomy (22.4%, 17/76 vs. 67.1%, 51/76, p < 0.001). There was a trend towards decreasing prevalence of H. pylori colonization as time after operation increased: 1-15 years, 29.5% (13/44); 16-30 years, 13.6% (3/22); and > 31 years, 10% (1/10). The spontaneous clearance rate of H. pylori after partial gastrectomy was 43% (13/30). The time after operation in the spontaneous clearance group was longer than that in those without (20.8 +/- 11.7 vs. 12.1 +/- 11.0 years, p = 0.048). Billroth-II procedure had a higher bile reflux rate and a lower H. pylori infection prevalence than the Billroth-I procedure.


CONCLUSIONS
Spontaneous clearance of H. pylori develops in a certain number of patients who undergo distal gastrectomy. The clearance rate is related to operative procedures and time after operation.
Bair
Ming-Jong
MJ
Division of Gastroenterology, Department of Internal Medicine, Mackay Memorial Hospital, Taitung, Taiwan.
Wu
Ming-Shiang
MS
Chang
Wen-Hsiung
WH
Shih
Shou-Chuan
SC
Wang
Tsang-En
TE
Chen
Chih-Jen
CJ
Lin
Ching-Chung
CC
Liu
Chia-Yuan
CY
Chen
Ming-Jen
MJ
D000328:Adult; D000368:Aged; D001655:Bile Reflux / Q000150:complications / Q000473:pathology; D016022:Case-Control Studies; D005260:Female; D005743:Gastrectomy / Q000009:adverse effects* / Q000706:statistics & numerical data*; D005753:Gastric Mucosa / Q000382:microbiology* / Q000473:pathology; D005763:Gastroenterostomy / Q000009:adverse effects; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000150:complications / Q000453:epidemiology* / Q000382:microbiology; D016480:Helicobacter pylori / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D010437:Peptic Ulcer / Q000150:complications / Q000382:microbiology / Q000601:surgery*; D015995:Prevalence; D011446:Prospective Studies; D013997:Time Factors