The development of mucosal changes after gastric surgery for ulcer disease.

The development of morphological changes in the body mucosa after partial gastrectomy for ulcer disease according to Billroth I and II was studied early (within 3 years) and late (10-24 years) postoperatively with gastroscopy and forceps biopsies. The morphological findings in the body mucosa of the operation specimens and biopsies from the stomas were compared. The effect of time, ulcer disease, operation procedure, sex, and age was studied. In duodenal ulcer patients, with significantly less pronounced inflammatory mucosal changes in the operation specimen, partial gastrectomy caused acute and chronic gastritis to the same degree as seen in gastric ulcer patients within 3 years postoperatively. Duodenal ulcer patients also developed mucosal atrophy, cystic dilatation of the gastric glands, and intestinal metaplasia by time to an extent not significantly different from what was found in gastric ulcer patients. No correlation could be found between the mucosal changes and factors like age, sex, or operation procedure. Mucosal atrophy, chronic gastritis, and intestinal metaplasia are regarded as possible features of malignant transformation. If this concept is true, our findings may explain why stump carcinoma is frequently reported with the same incidence independent of preoperative ulcer disease or anastomotic procedure.