Behavior of the infection by Helicobacter pylori of the gastric remnant after subtotal gastrectomy and Roux-en-Y anastomosis for benign diseases

Abstract

Introduction Reinfection by Helicobacter pylori of the gastric remnant after partial gastrectomy has been implicated in the development of gastric cancer at the gastric stump. Objective The aim of this study is to determine the rate of infection by H. pylori after partial gastrectomy and Roux-en-Y anastomosis for benign disease.

Materials and Methods A total of 79 patients with long segment Barrett's esophagus were submitted to vagotomy, anti-reflux surgery, two thirds distal gastrectomy, and Roux-en-Y anastomosis 70 cm long. In all preoperative biopsy samples were taken from the antrum. After surgery, four endoscopic studies were performed in different periods of time. Mean follow-up was 98 months after operation (60-240).

Results Three groups of patients were identified: (a) group 1, 43 patients (54%) who had no preoperative infection by H. pylori and remained so late after surgery; (b) group 2, 21 patients (27%) who had no preoperative infection by H. pylori but presented infection of the gastric remnant that increased parallel to the length of follow-up; (c) group 3, 15 patients (19%) who presented infection by H. pylori before surgery. From them, 11 showed reinfection of the gastric remnant, while four patients had no reinfection.

Conclusion After partial gastrectomy and Roux-en-Y anastomosis for benign disease, there are three different patterns of behavior regarding reinfection or not by H. pylori. A total of 41% of patients presented H. pylori reinfection at the gastric remnant after Roux-en-Y anastomosis, which increased parallel to the length of follow-up.