Association Between Subtotal Gastrectomy with Billroth II Anastomosis and Coronary Heart Disease

Abstract

Background: We assessed the risk of coronary heart disease (CHD) after subtotal gastrectomy with Billroth II anastomosis (SGBIIA) for peptic ulcer disease (PUD).

Methods: The Taiwan National Health Insurance Research Database was used, and 6160 patients undergoing SGBIIA for PUD were identified as the surgical cohort. A total of 24,540 patients from the PUD population not undergoing surgery selected by frequency-matching were identified as the non-surgical cohort. All patients were followed until the end of 2011 to measure the incidence of CHD.

Results: The cumulative incidence of CHD was lower in patients with SGBIIA than in those without surgery (16.9 vs 22.9 per 1000 person-year, adjusted hazard ratio [aHR] = 0.79, 95% confidence interval [CI] = 0.71-0.88). The risk of CHD, either acute coronary syndrome (ACS) (aHR = 0.83, 95% CI = 0.75-0.91) or other non-ACS CHD (aHR = 0.78, 95% CI = 0.68-0.88), was lower for the SGBIIA cohort than for the non-surgery cohort (aHR = 0.79, 95% CI = 0.71-0.88) after adjusting for age and the comorbidities of hypertension, diabetes mellitus, hyperlipidemia, stroke, congestive heart failure, chronic kidney disease, and chronic obstructive pulmonary disease.

Conclusions: We found SGBIIA is associated with a reduced risk of CHD for PUD patients.

Keywords: Coronary heart disease; Peptic ulcer disease; Roux-en-Y gastric bypass surgery; Subtotal gastrectomy with Billroth II anastomosis.