Graded gastrectomy for duodenal ulcer -- a five-year prospective study.

Area of Science:

• Gastroenterology
• Surgical Oncology
• Digestive System Diseases

Background:

• Duodenal ulcer disease management often involves surgical intervention.
• Partial gastrectomy techniques, like the Billroth II modification, are employed.
• Tailoring surgical extent based on patient physiology is a key consideration.

Purpose of the Study:

• To evaluate the efficacy of a graded gastrectomy approach for duodenal ulcer disease.
• To correlate surgical resection size with preoperative maximal acid output (MAO).
• To assess postoperative acid reduction and long-term sequelae, including atrophic gastritis.

Main Methods:

• One hundred twelve patients with duodenal ulcers underwent Moynihan modification of Billroth II partial gastrectomy.
• Resection size was graded: large (R, 2/3-3/4) for high MAO (>30 mEq/hr) and small (r, 1/3-1/2) for low MAO (<30 mEq/hr).
• Prospective follow-up at 3 months, 1 year, and 5 years included MAO measurements and assessment for atrophic gastritis.

Main Results:

• Preoperative MAO differed significantly between groups (R: 42.8 mEq/hr vs. r: 21.5 mEq/hr, p < 0.001).
• Postoperative MAO at 3 months was effectively reduced in both groups (R: 4.5 mEq/hr, r: 3.0 mEq/hr), confirming successful grading.
• Atrophic gastritis prevalence increased from 4% preoperatively to 72% at the 1-year follow-up.

Conclusions:

• Graded partial gastrectomy is effective in reducing gastric acid output according to individual patient secretory capacity.
• The surgical approach successfully differentiated between high and low acid secretors.
• A significant increase in atrophic gastritis necessitates further investigation into long-term implications.