위아전절제술 및 Billroth-II 문합술 후 잔위에서의 H. Pylorl 감염 및 조직소견

Abstract

Unconjugated bile acids inhibit the survival of Helicobacter pylori by modifying it's ultrastructure. The prevalence of H.pylori infection after subtotal gastrectomy and Billroth-II anastomosis has been known to be lower than that of intact stomach due to frequent contact with bile acids. In the present study, differences between anastomosis site and fundus were studied in 48 patients who had been undergone subtotal gastrectomy with Billroth-II anastomosis, because of gastric cancer. Total 26 men and 22 women were involved, and average duration between operation and endoscopic examination was 46.3 months (median 32.5 months). Three pieces of tissue were taken at both anastomosis site and fundus, and one piece was used for rapid urease test and others for histological examination. The Sydney system was used to classify the extent of gastritis. The prevalence of H.pylori infection was lower and the grade of intestinal metaplasia was higher in anastomosis site, however there were no differences in the grades of inflammation, activity, and atrophy between the two sites. The prevalence of H.pylori infection in anastomosis site was higher in the group of shorter postoperative duration. The grades of inflammation and activity at both sites were higher in the H.pylori-positive group. In conclusion, it is suggested that bile acids inhibit the survival of H.pylori and aggravate intestinal metaplasia, and that H.pylori has positive correlation with the grade of gastritis in remnant stomach