Helicobacter pylori infection in the remnant stomach after gastrectomy: With special reference to the difference between Billroth I and II anastomoses

Helicobacter pylori infection is associated with many gastric diseases, suc h as peptic ulcer and gastric cancer. We examined the remnant stomach for H . pylori infection after gastrectomy for gastric cancer or peptic ulcer bet ween October 1992 and July 1997. H. pylori DNA in the gastric juice of 109 patients [mean age 62.4 years, male/female 78/31, gastrectomy for gastric c ancer 83/peptic ulcer 26, Billroth I(BI) anastomosis 72/Billroth II (BII) 3 7, mean postoperative interval 6.0 years] was amplified by PCR and detected by Southern blot hybridization. The serum of 135 patients was assayed by E LISA for IgG antibody against H. pylori (mean age 61.8 years, male/female 9 9/36, gastrectomy for gastric cancer 111/peptic ulcer 24, BI anastomosis 93 /BII 42, mean postoperative interval 5.4 years). H. pylori was positive in 68/109 (62.4%) by PCR and 113/135 (83.7%) by ELISA. H. pylori cytotoxin gen e cagA, a H. pylori virulence factor gene, was found in 15/16 (93.8%) cases by PCR. A significant difference in H. pylori positivity by PCR was found according to the type of anastomosis (BI vs. BII) but not according to age group, sex, disease (cancer or ulcer), or postoperative interval by PCR and ELISA. BII anastomosis was followed by a significantly lower rate of H. py lori infection (17/37; 45.9%) than BI anastomosis (51/72; 70.8%; p=0.01) ac cording to the results of PCR. Moreover, some patients with BII anastomosis (3/8, 37.5%) showed positive to negative seroconversion for H. pylori infe ction after the operation (mean 2.47 years) according to the results of ELI SA, but this phenomenon was not observed in patients with BI (0/12) anastom osis. This may reflect the role of bile reflux, which is more common in BII than BI, because bile reflux interferes with colonization by H. pylori.