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Effect of Roux-en-Y biliary diversion on Campylobacter pylori

1989; Elsevier BV; Volume: 97; Issue: 4 Linguagem: Inglês

10.1016/0016-5085(89)91504-7

1528-0012

H J O’Connor, K. M. Newbold, J Alexander-Williams, Henry Thompson, J. Drumm, I A Donovan,

Veterinary medicine and infectious diseases

To assess the effect of biliary diversion on gastric colonization by Campylobacter pylori, we undertook a retrospective histologic study of 24 patients with symptomatic bile reflux after peptic ulcer surgery, who had endoscopic gastric biopsies performed before and after a Roux-en-Y operation.The time interval between the preoperative and postoperative endoscopic examinations ranged from 0.8 to 9.8 yr (mean 4.7 yr).The partial gastrectomy specimen, which had been resected at the initial operation, was available for assessment in 12 patients (50%).Biopsy specimens were assessed for the presence of C. pylori and scored for severity of reflux gastritis by the use of a histologic grading system.Ten of the 12 partial gastrectomy specimens (83%) were C. pylori-positive.Only 13 of the 24 patients (54%) were C. pylori-positive before the Roux-en-Y operation, rising to 22 (92%) after biliary diversion (P = 0.008).The median reflux score was 8 in the partial gastrectomy specimens: it rose to 11 before the Roux-en-Y operation and fell again to 8 after biliary diversion (p < 0.001).These results suggest that C. pylori may recolonize the gastric remnant after biliary diversion.P revious studies on the effect of operations for peptic ulcer on colonization with C. pylori (1,2) have shown that biopsy specimens of the gastric mucosa from patients undergoing operations that increase enterogastric reflux may change from being C. pylori-positive to C. pylori-negative and undergo a transition from C. pylori-related chronic gastritis to that associated with bile reflux.It is not known whether these mucosal changes are reversible after reoperations that divert upper intestinal contents away from the gastric remnant.Hence, the aim of this study was to assess the effect of Roux-en-Y (RY) biliary diversion on C. pylori status and on associated mucosal abnormalities in the stomach.