Helicobacter pylori Infection in the Remnant Stomach After Gastrectomy: With Special Reference to the Difference Between Billroth I and II Anastomoses

Abstract

Helicobacter pylori infection is associated with many gastric diseases, such as peptic ulcer and gastric cancer. We examined the remnant stomach for H. pylori infection after gastrectomy for gastric cancer or peptic ulcer between October 1992 and July 1997. H. pylori DNA in the gastric juice of 109 patients [mean age 62.4 years, male/female 78/31, gastrectomy for gastric cancer 83/peptic ulcer 26, Billroth I (BI) anastomosis 72/Billroth II (BII) 37, mean postoperative interval 6.0 years] was amplified by PCR and detected by Southern blot hybridization. The serum of 135 patients was assayed by ELISA for IgG antibody against H. pylori (mean age 61.8 years, male/female 99/36, gastrectomy for gastric cancer 111/peptic ulcer 24, BI anastomosis 93/BII 42, mean postoperative interval 5.4 years). H. pylori was positive in 68/109 (62.4%) by PCR and 113/ 135 (83.7%) by ELISA. H. pylori cytotoxin gene cagA, a H. pylori virulence factor gene, was found in 15/16 (93.8%) cases by PCR. A significant difference in H. pylori positivity by PCR was found according to the type of anastomosis (BI vs. BII) but not according to age group, sex, disease (cancer or ulcer), or postoperative interval by PCR and ELISA. BII anastomosis was followed by a significantly lower rate of H. pylori infection (17/37; 45.9%) than BI anastomosis (51/72; 70.8%; p=0.01) according to the results of PCR. Moreover, some patients with BII anastomosis (3/8; 37.5%) showed positive to negative seroconversion for H. pylori infection after the operation (mean 2.47 years) according to the results of ELISA, but this phenomenon was not observed in patients with BI (0/12) anastomosis. This may reflect the role of bile reflux, which is more common in BII than BI, because bile reflux interferes with colonization by H. pylori.

Evaluation of the efficacy of triple therapy regimen for Helicobacter pylori eradication in gastrectomized patients with gastric adenocarcinoma

“…We believe that this congruity occurred because the control group was of the same socioeconomic status as the patients in the literature. The prevalence of H. pylori in gastrectomized patients varies according to several factors; such as the postoperative period, the technique employed, and the age of the patient [19][20][21][22]. The prevalence of H. pylori in Billroth I gastrectomized patients varies from 36.9% to 80.3% [5,19,20], while that in Billroth II gastrectomized patients varies from 0% to 58% [19,20,23].…”

“…The prevalence of H. pylori in gastrectomized patients varies according to several factors; such as the postoperative period, the technique employed, and the age of the patient [19][20][21][22]. The prevalence of H. pylori in Billroth I gastrectomized patients varies from 36.9% to 80.3% [5,19,20], while that in Billroth II gastrectomized patients varies from 0% to 58% [19,20,23]. There are few references in the literature concerning H. pylori and Roux-en-Y diversion; however, this technique could provide a high prevalence rate having in mind that biliary reflux is damaging to H. pylori [20][21][22][23].…”

“…The prevalence of H. pylori in Billroth I gastrectomized patients varies from 36.9% to 80.3% [5,19,20], while that in Billroth II gastrectomized patients varies from 0% to 58% [19,20,23]. There are few references in the literature concerning H. pylori and Roux-en-Y diversion; however, this technique could provide a high prevalence rate having in mind that biliary reflux is damaging to H. pylori [20][21][22][23]. The study group presented an H. pylori prevalence of 71.4%.…”

A Collision Tumor Composed of Adenocarcinoma and Malignant Lymphoma in the Remnant Stomach After Pancreatoduodenectomy: Report of a Case

“…Moreover the colonization by H. pylori is disturbed by bile reflux after gastrectomy, especially after Billroth-II reconstruction. 12 According to most reports of the coexistence of adenocarcinoma and lymphoma, the lymphoma usually tends to be at an advanced stage and therefore, the prognosis of these patients chiefly depends on the stage of the lymphoma. 10,11 On the other hand, Nakamura et al reported that the survival probability for patients with double tumors appeared to be similar to that for patients with only gastric carcinoma; however, it was significantly worse than that for patients with only primary gastric lymphoma.…”

Helicobacter pylori infections - are these diseases relevant for surgical treatment?

“…Resection with B-I reconstruction shows an incidence of H. pylori infection of approximately 70%, followed by a significantly lower rate of infection in B-II anastomosis of 45% [71]. The lower rate of H. pylori infection found in B-II stomachs may reflect the role of bile reflux, which is more common in B-II than B-I and has been shown to interfere with the colonization by H. pylori.…”