Long-term prognosis after partial gastrectomy for gastroduodenal ulcer

The decline in duodenal ulcer disease and the established relation of pepti c ulcer to Helicobacter pylori have virtually abolished the need for electi ve ulcer surgery, However, a substantial proportion of the population aroun d retirement age has previously been subjected to partial gastric resection due to peptic ulcer, and the long-term outcome of these patients is of con tinuing relevance, Patients subjected to elective surgery could represent a selected group of healthy subjects with a lower overall morbidity, but rep orts indicate that patients operated on for peptic ulcer have more advanced disease associated with excess smoking and a different pattern of social b ehavior, The surgical procedure induces enterogastric reflux, leading to pr ofound changes in the remnant mucosa and the formation of carcinogens in th e gastric juice, In addition, metabolic abnormalities are common, especiall y fat malabsorption. Evaluation of the impact of these factors on morbidity and mortality is difficult. Increased mortality in gastrointestinal tumors (especially gastric stump carcinoma), respiratory diseases and other smoki ng-related malignancies, and suicide are found in the long-term follow-up a fter partial gastric resection due to peptic ulcer. However, these hazards to life are offset by a decreased mortality in cardiovascular disease. Prev entive measures against suicide and especially tobacco smoking are recommen ded to improve the outcome for this cohort.