HELICOBACTER-PYLORI AND RECURRENT ULCERATION AFTER HIGHLY SELECTIVE VAGOTOMY

Objective: To examine the relationship between Helicobacter pylori and recurrent ulceration after highly selective vagotomy (HSV). Setting: Academic Department of Surgery at a teaching hospital. Patients: Thirt y-eight patients (26 men and 12 women) were studied 2-21 years after H SV. Seven patients had recurrent ulceration. Each patient underwent te sts of acid secretion before and 1 week after HSV together with later endoscopic examination of the stomach and duodenum. Four biopsies were taken from the duodenum and gastric antrum. Results: There was no sta tistical difference in acid output between patients with and those wit hout recurrent ulceration (peak acid output 46.9 versus 55.8 mmol/h, r espectively; not significant) before operation. After operation, insul in stimulated acid secretion was significantly higher in patients who later developed recurrent ulceration (0.26 versus 4.1 mmol/h, respecti vely; P < 0.02). The endoscopic biopsies were tested for H. pylori inf ection (90 versus 86% for patients without and those with recurrent ul ceration, respectively; not significant), gastric metaplasia within th e duodenum (23 versus 14% for patients without and those with recurren t ulceration, respectively; not significant), antral gastritis (86 ver sus 71% for patients without and those with recurrent ulceration, resp ectively; not significant and antral intestinal metaplasia (52 versus 43% for those without and those with recurrent ulceration, respectivel y; not significant). Conclusion: H. pylori infection is not influenced by HSV and ulcer recurrence is determined by the completeness of vago tomy rather than by H. pylori status.