Insulin- and histamine-stimulated secretion in relation to recurrence of duodenal ulceration after vagotomy

Duodenal gastric metaplasia and Helicobacter pylori infection in high and low duodenal ulcer-prevalent areas in India

BACKGROUND

Previous reports, based on surgery, showed duodenal ulcer (DU) to be more common in the rice-eating areas of southern India than in the northern wheat-eating areas.

AIMS

Does this difference persist? Can it be explained by risk factors other than diet?

METHODS

A total of 20 053 records from patients undergoing endoscopy for dyspepsia, and 590 endoscopy patients from two northern and two southern centers in India were studied prospectively. Records were scrutinized to determine the relative incidence of DU and non-ulcer dyspepsia in wheat- and rice-eating areas. Age, sex, length of history, smoking and medication were recorded. Three antral biopsies and one from each duodenal quadrant were taken. A rapid urease test was carried out on one of the antral biopsies; the others were examined for Helicobacter pylori, gastritis, duodenitis and duodenal gastric metaplasia.

RESULTS

The difference in diet-associated prevalence persisted. No differences in smoking, Helicobacter pylori infection or duodenal gastric metaplasia were found between the two regions, but all three were more common in DU than in non-ulcer dyspeptic patients from both dietary areas.

CONCLUSIONS

The dietary differences between the regions remain the only factor to account for the differences in DU prevalence. A strong interrelationship between duodenal gastric metaplasia and cigarette smoking is demonstrated.

[Selective proximal vagotomy in the treatment of duodenal ulcer. Analysis of clinical results up to the 10th postoperative year]

807 patients with a duodenal ulcer were treated by a selective proximal vagotomy. Low inter- and postoperative complication rates led to a total mortality of 0.2%. Due to the maximum postoperative control the probability of suffering from a recurrent ulcer is 22.7%. Postoperative functional complaints appeared in 8-19% without the necessity of invasive treatment. A satisfactory result of the therapy was achieved in 73%. The clinical relevance of the analysis of gastric juice has to be discussed. A special emphasis was put on the description of frequency of follow-up examinations, the key of each clinical study.