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• W102567854 abstract "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.2Fifty 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 this group. Therefore the conclusion of Danesh et al that vagotomy is associated with a high prevalence of H pylori does not hold true for all patients who have had a vagotomy but only a subgroup of patients who had had a highly selective vagotomy. We believe that this may partly explain the poor results in terms of curing duodenal ulcer disease associated with highly selective vagotomy as most of the patients continued to harbour H pylori, which led to recurrent ulceration. In the group of patients who had had a partial gastrectomy, one reason for remission of H pylori was resection of the distal gastric tissue and another reason must again be bile reflux in the remnant stomach. This will depend on the reconstruction method that was used, and Danesh et al did not have sufficient details from their review to specify this. The most important finding from our study was that all patients with recurrent duodenal ulcer disease after vagotomy were positive for H pylori. We therefore agree with Danesh et al that there is a case for prescribing eradication treatment to this group of patients if they have symptoms." @default.
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• W102567854 date "1998-09-05" @default.
• W102567854 modified "2023-09-26" @default.
• W102567854 title "Helicobacter pylori and surgery" @default.
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• W102567854 doi "https://doi.org/10.1136/bmj.317.7159.679" @default.
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