Completeness of vagotomy, Helicobacter pylori colonization and recurrent ulcer 9 and 14 years after operation in duodenal ulcer patients

Abstract

Objective: To clarify the relationship between the completeness of vagotomy and Helicobacter pylori colonization in the development of recurrent ulcer (RU) during a long-term follow-up period after the operation in duodenal ulcer (DU) patients.

Design: 122 consecutive vagotomized DU patients were studied twice on average 9 and 14 years after vagotomy.

Methods: The presence of RU and completeness of vagotomy were assessed simultaneously endoscopically and by endoscopic Congo Red test (ECRT). The positive ECRT showed incomplete vagotomy. The amount of H. pylori in the biopsy specimens of the gastric antrum and corpus mucosa was detected histologically by microscopic counting.

Results: The cumulative increase in RU occurred from 4% (5/122) at 9 years to 18% (22/122) at 14 years (P < 0.001) and the rate of ECRT positive cases rose from 52 to 71%, respectively (P < 0.01). All RU cases were ECRT positive. H. pylori colonization occurred in 92% of cases at 9 years and in 98% of cases at 14 years. Vagotomy increased H. pylori prevalence in the corpus mucosa and the rate of the high intensity grade of H. pylori in the antrum and corpus mucosa.

Conclusion: The number of RU after vagotomy increases with time and is limited to patients with incomplete vagotomy. H. pylori colonization and the increased rate of its high intensity in the gastric mucosa after vagotomy may promote the development of RU only in incomplete vagotomy cases.