The affect of Helicobacter pylori and bile acids as the pathogenesis of gastritis of the remnant stomach after distal partial gastrectomy

AIMS: After distal partial gastrectomy with Billroth I reconstruction, gastritis of the remnant stomach was previously considered to be caused by bile reflux. However, since in 1982, Helicobacter pylori (HP) was discovered and it was found that this organism caused for many types of stomach diseases. The affect of HP must also be examined in the remnant stomach. In a current study, we examined the existence of HP and explored bile reflux as a pathogenesis of gastritis of the remnant stomach after distal partial gastrectomy. PATIENTS AND METHODS: The subjects were 56 patients who underwent gastrectomy. The existence of HP was investigated before and after gastrectomy. At postoperative gastroscopy, we examined histological findings of remnant gastritis and total bile acid (TBA) concentration in the gastric juice. Then we assessed the effect of HP and TBA on gastritis regarding the time after gastrectomy. RESULT: HP was positive in 75% of the patients before the operation and in 37.5% after the operation. The HP positive ratio was significantly lower in patients more than 5 years after gastrectomy than in those within 5 years. Inflammatory cell infiltration of the remnant gastric mucosa was more prominent in HP positive patients than in HP negative patients. In HP positive remnant stomachs, the TBA concentration of the gastric juice was lower than in HP negative remnant stomachs. CONCLUSION: Within 5 years after distal partial gastrectomy, gastritis of the remnant stomach was mainly caused by HP.