Gastric outlet obstruction resulting from peptic ulcer disease requiring surgical intervention is infrequently associated with Helicobacter pylori infection

Background: Gastric outlet obstruction (GOO) secondary to peptic ulcer dise ase requiring therapeutic intervention remains a common problem. The incide nce of Helicobacter pylori infection in this cohort has not been well defin ed. Pneumatic dilatation (PD) has been proposed as first-line therapy befor e surgical intervention. If H pylori infection in patients with GOO is infr equent, PD may not offer permanent control without the need for longterm an tacid therapy. Study Design: The purpose of this study was to examine the incidence of H p ylori infection and surgical outcomes in patients undergoing resection for GOO. The records of all patients having resection (vagotomy and antrectomy) for benign disease from 1993 to 1998 for GOO at the University of Tennesse e affiliated hospitals were reviewed retrospectively. Smoking history, NSAI D use, weight loss, previous ulcer treatment, previous treatment for H pylo ri, and previous attempts at PD were among the factors examined. H pylori i nfection was documented by Steiner stain from either preoperative biopsy or , in most patients, final surgical specimens. Surgical complications and pa tient satisfaction mere ascertained from inpatient records, postoperative c linical notes, and, where possible, followup telephone surveys. Results: Twenty-four patients underwent surgical resection during the study period. There were IG men and 8 women, with a mean age of 61 years (range 40 to 87 years). Weight loss was documented in 58% and averaged 27 Ib. Five of 24 patients had previous attempts at PD, 3 of whom were H pylori negati ve. All five had further weight loss after these failed attempts. Of the 24 patients reviewed, only 8 (33%) were H pylori positive. There were no proc edure-related deaths. Longterm clinical followup was possible in 16 of 24 p atients, and all but one demonstrated dramatic clinical improvement by Visi ck score, Conclusions: We conclude the following: 1) In this cohort, H pylori infecti on was present in a minority; 2) previous attempts at PD were unsuccessful, which may be related to the H pylori-negative status of the patients; 3) m ortality related to the operation was zero; and 4) patient satisfaction was positive by the Visick scale. Patients with H pylori-negative GOO resultin g from peptic ulcer disease should be strongly considered for an early; def initive, acid-reducing surgical procedure. (J Am Coil Surg 2000;191:32-37. (C) 2000 by the American College of Surgeons).