COMPLETENESS OF VAGOTOMY, HELICOBACTER-PYLORI COLONIZATION AND RECURRENT ULCER 9 AND 14 YEARS AFTER OPERATION IN DUODENAL-ULCER PATIENTS

Objective To clarify the relationship between the completeness of vago tomy and Helicobacter pylori colonization in the development of recurr ent ulcer (RU) during a long-term follow-up period after the operation in duodenal ulcer (DU) patients. Design 122 consecutive vagotomized D U patients were studied twice on average 9 and 14 years after vagotomy . Methods The presence of RU and completeness of vagotomy were assesse d simultaneously endoscopically and by endoscopic Congo Red test (ECRT ), The positive ECRT showed incomplete vagotomy, The amount of H. pylo ri in the biopsy specimens of the gastric antrum and corpus mucosa was detected histologically by microscopic counting. Results The cumulati ve increase in RU occurred from 4% (5/122) at 9 years to 18% (22/122) at 14 years (P< 0.001) and the rate of ECRT positive cases rose from 5 2 to 71%, respectively (P< 0.01). All RU cases were ECRT positive. H. pylori colonization occurred in 92% of cases at 9 years and in 98% of cases at 14 years. Vagotomy increased H. pylori prevalence in the corp us mucosa and the rate of the high intensity grade of H. pylori in the antrum and corpus mucosa. Conclusion The number of RU after vagotomy increases with time and is limited to patients with incomplete vagotom y, ii, pylori colonization and the increased rate of its high intensit y in the gastric mucosa after vagotomy may promote the development of RU only in incomplete vagotomy cases, (C) 1998 Lippincott-Raven Publis hers.