Changes in gastric glands after gastric surgery in symptomatic patients

Surgery for peptic ulcer disease results in hypochlorhydria and increased biliary and pancreatic reflux. These factors are believed to lead to mucosal gland change, which may progress to carcinoma. In 31 patients who had undergone gastric surgery for duodenal ulcer disease we found macroscopic lesion in 94% and microscopic abnormality in 84%, either in the anastomotic site or in the gastric stump mucosa. The average time duration from the operation was 11.6 years. Dysplasia of gastric glands was found in 13% of the cases, with no evidence of malignancy. In 42% of the patients cystic change of the gland was found in association with an inflammatory macroscopic lesion (mucosal hyperemia and fragility, ulcer or polyp) and periodic acid-Schiff-positive Alcian blue-negative staining (red color) characteristic of neutral mucin (as in normal glands). These findings support a reactive, hyperplastic change of glands, rather than a true proliferative disorder. It is suggested that mucosal gland change often follows gastric surgery.