Effect on alkalen reflux gastritis, histology of the antral mucosa and Helicobacter pylori colonization of cholecystectomy

Yıl 2005, Cilt: 4 Sayı: 1, 13 - 17, 01.04.2005

Gürsel Bayram Bülent Ödemiş Bahattin Çiçek Osman Yüksel Erkan Parlak Neslihan İ. Zengin Burhan Şahin

Öz

Background/aim: Although cholecystectomy is the standard therapy for symptomatic gallbladder stones, it may lead to anatomic and functional changes that induce duodenogastric reflux. The aim of this study was to evaluate the relationship between cholecystectomy and alkaline reflux, antral mucosal changes, and colonization of Helicobacter pylori. Materials and methods: One hundred and thirty-five cases (104 female, 31 male; 56.25±11.35 years old) with cholecystectomy and 50 (35 female, 15 male; 55.48±12.50 years old) control cases were included in this prospective study. Patients with cholecystectomy were subclassified according to the time interval after cholecystectomy (≤5 years, 5-9 years, ≥10 years). All patients were investigated for alkaline reflux gastritis by upper gastrointestinal endoscopy. Mucosal histopathologic changes and Helicobacter pylori existence were evaluated in endoscopic biopsies obtained from the antrum. Results: Alkaline reflux gastritis in the cholecystectomy group (58.5%) was significantly higher than in the control group (6%). There was no significant difference between groups regarding to Helicobacter pylori existence, intestinal metaplasia, chronic active gastritis and chronic atrophic gastritis. Presence of alkaline reflux gastritis was significantly higher in all cholecystectomy subgroups than in the control group, but there were no significant differences between values among cholecystectomy subgroups. Rates of Helicobacter pylori, intestinal metaplasia, chronic active gastritis and chronic atrophic gastritis were similar between the control group and cholecystectomy subgroups and also among cholecystectomy subgroups. Conclusion: Cholecystectomy often leads to endoscopic alkaline reflux gastritis. Nevertheless, it does not influence Helicobacter pylori colonization nor cause antral mucosal histopathological changes.

Anahtar Kelimeler

Alkaline reflux gastritis, helicobacter pylori, cholecystectomy

Kolesistektominin alkalen reflü gastrit, antral mukoza histolojisi ve Helikobakter pylori kolonizasyonu üzerine etkisi

Öz

Giriş ve amaç: Kolesistektomi semptomatik safra taşları için standart tedavi
olmasına rağmen duodenogastrik reflüyü indükleyen anotomik ve
fonksiyonel değişikliklere yol açabilir. Bu çalışmanın amacı kolesistektomi
ile alkalen reflü, antral mukozal değişiklikler ve H. pylori kolonizasyonu
arasındaki ilişkiyi araştırmaktır. Gereç ve yöntem: Bu prospektif
çalışmaya 135 kolesistektomili (104 kadın, 31 erkek; 56.25±11.35 yıl)
ve 50 kontrol hastası (35 kadın, 15 erkek; 55.48±12.50) alındı. Kolesistektomi
geçiren grup kendi içerisinde kolesistektomi yılına göre sınıflandırıldı
(≤5 yıl, 6-9 yıl, 10 ≥). Tüm hastalara üst gastrointestinal endoskopi
yapılarak alkalen reflü gastrit varlığı değerlendirildi. Antrumdan alınan endoskopik biyopsilerde mukozadaki histopatolojik değişiklikler ve
H. pylori varlığı araştırıldı. Bulgular: Alkalen reflü gastrit kolesistektomi
grubunda (%58.5) kontrol grubuna (%6) göre anlamlı olarak yüksek
saptandı. H. pylori, İntestinal metaplazi, kronik aktif gastrit, ve kronik
atrofik gastrit açısından iki grup arasında anlamlı farklılık yoktu. Yıllara
göre kolesistektomi grubu snıflandırılarak yapılan değerlendirmede alkalen
reflü gastrit kolesistektomi gruplarının tamamında kontrol grubuna
göre anlamlı olarak yüksekti, ancak kolesistektomi grupları arasında
anlamlı farklılık yoktu. H. pylori, intestinal metaplazi, kronik aktif gastrit
ve kronik atrofik gastrit açısından kontrol ile kolesistektomi grupları
arasında ve kolesistektomi gruplarının kendi arasında istatistiksel olarak
anlamlı bir fark bulunmadı. Sonuç: Kolesistektomi endoskopik alkalen
reflü gastrite yol açmakla beraber antrum mukozasında histolojik deği-
şiklere yol açmaz ve H. pylori kolonizasyonunu etkilemez.

Anahtar Kelimeler

Alkalen reflü gastrit, helikobakter pylori, kolesistektomi

Kaynakça

• Manifold DK, Chir B, Anggiansah A, et al. Effect of cholecystectomy on gastroesophageal and duodenogastic reflux. Am J Gastroenterol 2000; 95: 2746-50.
• Perdikis G, Wilson P, Hinder R, et al. Altered antroduodenal moti- lity after cholecystectomy. Am J Surg 1994; 168: 609-14.
• Luman W, Williams AJ, Pryde A, et al. Influence of cholecystectomy on sphincter of oddi motility. Gut 1997; 41: 371-4.
• Bailey I, Walsh TN, Hill AD, et al. Effect of cholecystectomy on plas- ma cholecystokinin. Br J Surg 1992; 79: 456.
• Rothwell JF, Lawlor P, Byrne PJ, et al. Cholecystectomy-induced gastroesophageal reflux: is it reduced by the laparoscopic appro- ach? Am J Gastroenterol 1997; 92: 1351-4.
• Eastwood GL. Effect PH on bile salt injury to mouse gastric muco- sa. Gastroenterology 1997; 69: 591-7.
• Houghton PWJ, Mortensen NJMcC, Thomas WEG, et al. Intragast- ric bile acids and hisdtological changes in gastic mucosa. Br J Surg 1986; 73: 354-6.
• Dixon MF, O’connor HJ, Axon ATR, et al. Reflux gastritis: distinct histopathological entity? J Clin Pathol 1986; 39: 524-30.
• O’Connor HJ, Wyatt JI, Dıxon MF, et al. Campylobacter like orga- nisms and reflux gastritis. J Clin Pathol 1986; 39: 531-34.
• Scalon P, Di Mario F, Del Favero G, et al. Biochemical and histo- pathological aspects in duodenogastric reflux gastritis patients with or without prior cholecystectomy. Acta Gastroenterol Belg 1993; 565: 215-8.
• Lee SP. The stomach after cholecystectomy. Am J Surg 1983; 145: 325-7.
• Miller LJ, Resseguie LJ, Taylor WF, et al. Cholecystectomy and gastric ulcer-an etiologic relationship. Mayo Clin Proc 1980; 55: 255-7.
• Elhak NG, Elwahab MA, Nasif WA, et al. Prevelance of Helicobac- ter pylori, gastric myoelectrical activity, gastric mucosal changes and dyspeptic symptoms before and after laparoscopic cholecystec- tomy. Hepato-Gastroenterology 2004; 51: 485-490.
• Ritchie WP. Alkaline reflux gastritis. A critical reappraisal. Gut 1984; 25: 975-87.
• Price AB. The Sydney System Histological division. J Gastroenterol Hepatol 1991; 6: 209-22.
• Maddern GJ, Baxter PS. The effect of laporoscopik cholecystectomy on gastroduodenal reflux. Aust New Zealand J Surg 1997; 67: 703- 5.
• Hubens A, Van de Kelft E, Roland J. The influence of cholecystec- tomy on the duodenogastric reflux of bile. Hepatogastroenterology 1989; 36: 384-6.
• Brough WA, Taylor TV, Torrance HB. The effect of cholecystectomy on duodenogastic reflux in dogs and humans. Scand J Gastroente- rol 1984; 92: 242-4.
• Watson RG, Love AH. Intragastic bile acid concentrations are un- related to symptoms of flatulent dyspepsia in patients with and wit- hout gallbladder diseases and postcholecystectomy. Gut 1987; 28: 131-6.
• Lorusso D, Misciagna G, Mangini V, et al. Duodenogastric reflux of bile acid, gastrin and parietal cells, and gastric acid secretion befo- re and 6 months after cholecystectomy. Am J Surg 1990; 159: 575- 8.
• Brown TH, Walton G, Cheadle WG, et al. The alkaline shift in gast- ric pH after cholecystectomy. Am J Surg 1989; 157: 58-65.
• Abdel-Wahab M, Abo-Elenein A, Fathy O, et al. Does cholecystec- tomy affect antral mucosa? Endoscopic, histopathologic and DNA flow cytometric study. Hepato-Gastroenterology 2000; 47: 621-5.
• Müller-Lissner SA, Schindlbeck NE, Heinrich C. Bile Salt reflux af- ter cholecystectomy. Scand J Gastroenterol 1987; 22: 20-4.
• Kellosalo J, Alavaikko M, Laitinen S. Effect of biliary tract proce- dures on duodenogastric reflux and the gastric mucosa. Scand J Gastroenterol 1991; 26: 1272-8.
• Freedman J, Ye W, Naslund E, Lagergren J. Association between cholecystectomy and adenocarcinoma of the esophagus. Gastroen- terology 2001; 121: 548-53.
• Hyvarinen H, Sipponen P, Kekki M. Chronic gastritis in cholecys- tectomized patients. Scand J Gastroenterol 1987; 22: 649-54.
• Farsakh NA, Roweily E, Steitieh M, et al. Prevalance of Helicobac- ter pylori in patients with gall stones before and after cholecystec- tomy: a longitudinal study. Gut 1995; 36: 675-8.
• Lorusso D, Pezzolla F, Cavallini A, et al. A prospective study of do- denogastic reflux and on histological changes in gastric mucosa af- ter cholecystectomy. Gastroenterol Clin Biol 1992; 16: 328-33.
• Zullo A, Rinaldi V, Hassan C, et al: role of Helicobacter pylori and bile reflux. J Clin Gastroenterol 1998; 27: 335-8.
• Tewari SN, Cerezo L, Price G. The prevelance of Campylobacter pylori gastritis: A study of symptomatic nonulcer dyspepsia and bi- le gastritis. J Clin Gastroenterol 1989; 11: 271-7.
• Caldwell MT, McDermott M, Jazrawi S, et al. Helicobacter pylori infection increass following cholecystectomy. Ir J Med Sci 1995; 164: 52-5.
• Fukuhara K, Osugi H, Takada N, et al. Duodenogastric reflux era- dicates helicobacter pylori after distal gastrectomy. Hepatogastro- enterology 2004; 51:1548-90.