Biopsies of 17
peptic ulcer patients, randomly treated by partial
gastrectomy with either
Billroth-II (n = 9) or Roux-en-Y (n = 8) anastomosis were studied before and six months after surgery to determine the role of
bile reflux in the early postoperative histological alterations of the gastric mucosa. After BII-
gastrectomy bile acid reflux (median 16.1 mumol/h) was significantly higher (p less than 0.0001) than after RY-
gastrectomy (0.1 mumol/h). Campylobacter pylori was present in the preoperative biopsies of all 17 patients. After RY-
gastrectomy biopsies of all eight patients were positive for Campylobacter pylori, but was detected in only five of the nine patients with BII-
gastrectomy. Preoperative scores of
gastritis grading were similar in both groups and no significant differences were found postoperatively.
Gastritis scores of the anastomotic mucosa in patients with BII-
gastrectomy were significantly higher (p less than 0.02) than in the RY-
gastrectomy group. Moreover, the reflux
gastritis score in the four BII-
gastrectomy patients cleared from Campylobacter pylori was significantly higher (p less than 0.02) than in the postgastrectomy patients harbouring Campylobacter pylori. The results suggest that reflux
gastritis and Campylobacter pylori related
gastritis are distinct microscopic entities and that
bile reflux may play a role in the eradication of Campylobacter pylori after
gastrectomy.