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Helicobacter pylori-Induced Damage to the Gastric Mucosa is Not Modulated by Previous Vagotomy or Medical Treatment of Peptic Ulcer Disease: A Comparative Study of Vagotomized Patients, Medically Treated Peptic Ulcer Patients and Community Control Subjects

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Abstract

Background

An increase in the prevalence of precancerous lesions and atrophic changes in the gastric mucosa has been reported as long-term consequences of vagotomy-induced acid suppression. This study was designed to describe the long-term changes in the gastric mucosa caused by vagotomy and Helicobacter pylori infection.

Methods

Seventy-nine patients with vagotomized peptic ulcers, 70 nonoperated patients with peptic ulcers, and 85 matched community control subjects were randomly selected to participate in an upper endoscopic study. Biopsy specimens were taken from predestined locations of the gastric mucosa.

Results

Mean follow-up time for the vagotomized patients was 17.3 (range, 6–28) years and 12.7 (range, 10–17) years for the medically treated peptic ulcer patients. In H. pylori-positive subjects, severe atrophic changes in the distal gastric mucosa (prepylorus and angulus) was found in 30% (95% confidence interval (CI), 19–43) of the vagotomized patients and in 43% (95% CI, 29–58) of medically treated patients with peptic ulcers, and in 32% (95% CI, 20–46) of the community control subjects. Severe intestinal metaplasia was not found more frequently in vagotomized peptic ulcer patients compared with medically treated patients with peptic ulcers (p = 0.5). The histological picture of the age-matched community control subjects did not differ significantly from the patients with peptic ulcers when corrected for presence of H. pylori infection.

Conclusions

This study lends no support to theories of increased premalignant changes in the gastric mucosa of vagotomized patients. H. pylori infection rather than long-term acid suppression seems to be the explanation of the gastric mucosal changes seen after vagotomy.

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Acknowledgements

This study was supported by grants from the Norwegian Medical Associations fund for quality improvement, Tromsø University Hospital research fund, and The Norwegian Research Council. The authors thank the staff of our Department for Clinical Investigation for their excellent service to the patients and their valuable contribution in the administration of the study.

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, University Hospital of North Norway, Institute of Clinical Medicine, Tromsø University, 9038, Tromsø, Norway

    Rolv-Ole Lindsetmo & Arthur Revhaug

  2. Department of Pathology, The National Hospital, Oslo University, Oslo, Norway

    Tor Jac Eide

  3. Institute of Community Medicine, Tromsø University, Tromsø, Norway

    Roar Johnsen

Authors
  1. Rolv-Ole Lindsetmo
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  2. Tor Jac Eide
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  3. Roar Johnsen
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  4. Arthur Revhaug
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Correspondence to Rolv-Ole Lindsetmo.

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Lindsetmo, RO., Eide, T.J., Johnsen, R. et al. Helicobacter pylori-Induced Damage to the Gastric Mucosa is Not Modulated by Previous Vagotomy or Medical Treatment of Peptic Ulcer Disease: A Comparative Study of Vagotomized Patients, Medically Treated Peptic Ulcer Patients and Community Control Subjects. World J Surg 32, 2267–2274 (2008). https://doi.org/10.1007/s00268-008-9690-x

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