RESEARCH – August 2003

Gastric corpus mucosa atrophy, serum pepsinogen I and vagotomy: a long-term study of duodenal ulcer patients


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The aim of this work was to study the relationship between chronic active gastritis and gastric mucosa atrophy as well as how vagotomy affects simultaneous development of gastric mucosa atrophy and intestinal metaplasia (IM) together with the appearance of low serum pepsinogen I (S-PgI) values, depending on completeness of vagotomy, in duodenal ulcer (DU) patients during an average of 14-year follow-up. A total of 122 vagotomised patients underwent outpatient investigations on average 9 and 14 years after operation: upper gastrointestinal endoscopy plus taking of samples from the corpus and antrum mucosa for histology and performing of endoscopic Congo red test (ECRT) for assessment of completeness of vagotomy. S-PgI was determined from the blood serum using radioimmunological method. Depending on the ECRT results, the 122 patients were divided into two groups: I – 35 patients in whom ECRT was negative (complete vagotomy) during 14 years, II – 87 patients in whom ECRT proved positive (incomplete vagotomy) 14 years after operation. In group I corpus mucosa atrophy developed in 46% of the cases, among them moderate atrophy in half of the cases; antrum mucosa atrophy, in most cases mild atrophy, developed in 31% of the cases. In group II mostly mild atrophy developed in 17 – 19% of the cases both in the antrum or corpus. There occurred a significant correlation between progression of chronic active gastritis and mucosa atrophy in the corpus but not in the antrum. Fourteen years after vagotomy, low S-PgI values were recorded more frequently in group I than in group II, 18% and 2% (p<0.05), respectively, while in group I low values were observed in 12% of the cases, together with moderate corpus atrophy and mild IM, which was not noted in group II. Fourteen years after vagotomy, neither severe atrophy nor moderate or severe IM were observed, as a rule, in neither group. Fourteen years after vagotomy, a significant correlation occurred between progression of chronic active gastritis and gastric atrophy in the corpus but not in the antrum of the duodenal ulcer patients. Unlike incomplete vagotomy, complete vagotomy causes more frequently gastric corpus atrophy, including moderate atrophy together with mild IM and low S-PgI. As a rule, vagotomy does not lead either to severe atrophy of the gastric mucosa, or to moderate or severe intestinal metaplasia during 14 years.