Epithelial proliferation in human fundic mucosa after antrectomy and vagotomy

Changes in the gastric mucosa after a partial gastrectomy may predispose to neoplasia, but epithelial proliferation in such patients has not been studied well. Therefore, we obtained one or more suction biopsies of fundic mucosa from 6 volunteers (controls), 5 patients in whom a duodenal ulcer had healed, and 6 patients with antrectomy and vagotomy. Biopsies were organ cultured over tritiated thymidine-containing medium to label proliferating cells, and processed for light microscopy and autoradiography. The measurements of proliferation that were used, namely, the total number of cells in the gastric pits, the number of cells in the proliferative zone, the number of labeled cells in the proliferative zone, and proliferation index (number of cells in the proliferative zone/total number of cells in the gastric pit) all indicated that epithelial proliferation is increased significantly in fundic mucosa of patients after antrectomy and vagotomy when compared with fundic mucosa from normal controls or patients with healed duodenal ulcer. Proliferation was increased most in biopsies that showed atrophic gastritis. The enhancement of epithelial proliferation after antrectomy and vagotomy may be due to the development of gastritic changes, but an additional effect of vagotomy cannot be excluded. Further, the expansion of the proliferative zone suggests a disorder of proliferation which may predispose to malignant transformation.