Gastritis, duodenogastric reflux and bacteriology of the gastric remnant in patients operated for peptic ulcer by Billroth I operation.

Of 101 patients undergoing Billroth I gastrectomy (BI) 14 years previously, we were able to investigate 39. General abdominal symptoms, haematological status, basal (BAO) and maximal (MAO) hydrochloric acid secretion were studied before (I) and 1 year (II) and 14 years (III) after the operation. Stump mucosa morphology was investigated before the operation and 14 years afterward. Duodenogastric reflux with radioisotope and fasting bile reflux methods and stump bacteriology were studied at the last follow-up and compared with those of controls who had had peptic ulcer 15 years ago. Only 10% of the operated patients could be classified as Visick Grade III, the others being Grades I-II. At the time of the follow-up, mean body weight had not changed. Serum iron was better at 14 than one years after the operation. BAO and MAO decreased significantly after the operation, but these decreases did not continue during the postoperative period. Duodenogastric reflux was significantly greater in the gastrectomized patients than in the controls. Neither the progression of gastritis nor the degree of postoperative gastritis correlated with the reflux. Of the operated patients, 6% had normal stump mucosa and 80% had atrophy. From the stump we cultured colonic bacteria in 44% of the patients, pharyngeal flora in 71% and Candida in 56%. The stomach bacteriology of the controls was: 10% colonic, 35% pharyngeal flora and 30% Candida. The general status of BI-patients remains good. Although gastritis progresses to atrophy and duodenogastric reflux increases, the reflux and atrophy do not seem to be related. In spite of increasing atrophy hydrochloric acid secretion continues.