Helicobacter pylori and surgery

BMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7159.679 (Published 05 September 1998) Cite this as: BMJ 1998;317:679

Bile reflux is important in eradicating Helicobacter pylori

  1. D Karat, Specialist registrar in surgery,
  2. S M Griffin, Consultant surgical gastroenterologist
  1. Northern Oesophagogastric Unit, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP
  2. Royal Liverpool University Hospital, Liverpool L7 8XP.
  3. Kingston Hospital, Kingston upon Thames, Surrey KT2 7QB
  4. Department of Medicine and Gastroenterology, Queen Alexandra Hospital, Portsmouth PO6 3LY
  5. Clinical Trial Service Unit and Epidemiological Studies Unit, University of Oxford, Radcliffe Infirmary, Oxford OX2 6HE

    EDITOR—Danesh et al reviewed data regarding the incidence of Helicobacter pylori in patients who had undergone vagotomy for peptic ulcer disease.1 Our prospective study from 1996 on the same subject was, however, not included in the analysis.2

    Fifty four patients who had had a vagotomy for duodenal ulcer disease and 50 patients with duodenal ulcer disease who had not had an operation had an endoscopy, and H pylori status was determined. H pylori was detected in 94% of those who had not had an operation, but in only 52% of those who had had a vagotomy.

    We found significant differences in H pylori infection in the group who had had a vagotomy, however, depending on the exact procedure performed. Altogether 61% of patients who had had pyloroplasty were positive for H pylori, compared with only 25% of those who had had gastroenterostomy and all of those treated by highly selective vagotomy. We reached the same conclusion as Danesh et al and suggested that duodenogastric reflux of bile was important in eradicating the organism and therefore procedures associated with significant bile reflux, such as gastroenterostomy, resulted in lowest colonisation rates by H pylori.

    Danesh et al showed a higher overall prevalence of H pylori after vagotomy (83%) than we did, but most of the data concerned were collected after highly selective vagotomy, which is associated with no increase in bile reflux, and we found H pylori in all such patients in …

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