Long-term follow-up after Billroth I and II partial gastrectomy. Gastrointestinal tract function and changes in bone metabolism.

Late results of Billroth I (BI) partial gastrectomy for peptic ulcer in 19 patients were compared with those in 19 patients who had undergone Billroth II (B II) operation. The groups were matched for age and sex and were re-examined 21 to 27 years postoperatively. The study included notation of abdominal symptoms and haematologic status and tests of calcium metabolism with serum D-vitamin concentrations [S-25(OH)D2 and S-25(OH)D3], A-vitamin absorption, lactose and d-xylose tolerance and barium meal transit time to assess intestinal function, gastroscopy with biopsies, and measurement of bone mineral density, using the 241Am gamma ray attenuation method. In the paired comparisons of B I and B II patients, no significant difference was found in haematologic status or results of intestinal function tests. The serum alkaline phosphatase activity was significantly higher after B II than after B I, whereas S-25(OH)D2 and S-25(OH)D3 were significantly higher in the B I group. Other data for calcium metabolism showed no significant intergroup difference. Bone mineral density likewise was not significantly different in the two groups, but in both of them the values were significantly lower than in healthy control subjects. Most patients in both Billroth groups had atrophic mucosal gastritis.