Relationship between Helicobacter pylori and histological changes in the gastric remnant after subtotal gastrectomy.

OBJECTIVE

The aim of this study was to clarify the influence of histological changes in the gastric remnant on Helicobacter pylori (H. pylori) infection after distal gastrectomy (DG) and proximal gastrectomy (PG).

METHODS

In total, 101 patients who underwent DG (n = 76) or PG (n = 25) for gastric cancer were included in the study. Three biopsy specimens from the remnant stomach were obtained during upper gastrointestinal endoscopy. Each specimen was scored according to the updated Sydney system for classifying gastritis and was examined for H. pylori infection.

RESULTS

The H. pylori infection rate after DG was 60.5% while that after PG was 20.0% (P < 0.001). The histological score for neutrophils after DG was 60.5% while that after PG was 12.9% (P < 0.001). Intestinal metaplasia after PG was 76.0% while that after DG was 22.4% (P < 0.001). No differences in mononuclear cells or atrophy were observed between the two gastrectomy groups.

CONCLUSIONS

H. pylori infection occurred more frequently after DG than after PG. Histological inflammation of the gastric remnant after DG was higher than that after PG. Intestinal metaplasia of the gastric remnant after PG was higher than that after DG. The intestinal metaplasia that induced inflammation indicated that H. pylori infection after PG was at a low level.