The course of Helicobacter pylori infection after partial gastrectomy for peptic ulcer disease

While the number of patients operated on for peptic ulcer disease is decreasing, many underwent surgery before the Helicobacter pylori era. Some of them later develop ulcer relapses. The aim of this study was to evaluate the course of H. pylori infection in the gastric remnant after surgery for peptic ulcer disease.

This study included 90 consecutive partial gastrectomy patients, obtained from gastroscopy registers of the Department of Surgery, Helsinki University Central Hospital, between 1985 and 1988, in whom both pre- and postoperative samples were available. All of the patients had undergone partial gastrectomy at some time between 1925 and 1988. The median interval between operation and reference gastroscopy was 5 years.

Twenty-three patients had a recurrent ulcer, and an additional six patients had a history of an earlier ulcer recurrence. Preoperative H. Pylori infection (68%) did not correlate significantly with the ulcer recurrence rate. The recurrence rate was higher in patients with Billroth I (BI) (27%) and Billroth II (BII) (33%) reconstructions than in those with a Roux-en-Y type reconstruction (9%, BII vs Roux-en-Y, p = 0.02, BI vs Roux-en-Y, p = 0.12). At the time of reference gastroscopy, the proportion of H. pylori positive patients was 38%. The presence of H. pylori at the time of reference gastroscopy did not correlate with ulcer recurrence. A recurrent. ulcer was more often found in patients with histologically normal gastric mucosa in the stump than in those with H. Pylori infection (35% and 19%, p = 0.25).

A persistent H. pylori infection is frequently seen in the gastric remnant after operation for peptic ulcer disease, but the infection does not seem to cause ulcer relapses in the gastric stump or in the anastamosis.