Histologic changes after elective surgery for duodenal ulcer.

Histologic changes in gastric mucosal biopsies were assessed in men who 2 to 19 years previously had undergone surgery for duodenal ulcer. Six groups, each of 40 patients, were studied. Surgery had been performed in four groups, viz. Pólya gastrojejunostomy, truncal vagotomy with antrectomy, truncal vagotomy with drainage (gastrojejunostomy or pyloroplasty) or proximal gastric vagotomy. One control group was medically treated for duodenal ulcer and another had no signs of gastroduodenal disorder. The incidence of atrophic gastritis was significantly higher after the Pólya operation than after the other three procedures. However, truncal vagotomy with antrectomy and truncal vagotomy and drainage were associated with high incidence of intramucosal cysts. Intramucosal cysts were not seen after proximal gastric vagotomy. Gastric stump carcinoma appeared in three patients after Pólya gastrectomy, with origin in the gastroenterostomy area. The findings indicate vulnerability of that area. All the operations evoked pathologic changes, except for proximal gastric vagotomy, after which the incidence of atrophic gastritis was similar to that found in the control groups.