Clinical features analysis of 272 patients with gastric stump ulcer

Abstract

Objective To investigate the clinical features of gastric stump ulcer （GSU）after partial gastrectomy due to gastroduodenal ulcer.Methods From January 1st 2007 to October 31th 2013,272 patients with partial gastrectomy for gastroduodenal ulcer underwent gastroscopy due to upper gastrointestinal symptoms were collected.Among them,there were 237 male patients and 35 female patients with the average age （55 .4 ± 13.0 ）years.The lesion location,symptoms and pathological changes of GSU were analyzed.Chi-square test and Fisher exact probability analysis were used for count data comparison.The t test was performed for measurement data comparison.Results There was no significant difference between patients with GSU after Billroth Ⅰ gastrectomy and Billroth Ⅱ gastrectomy in the incidence of dysphagia,nausea and vomiting,retrosternal pain,retrosternal buring sensation,upper abdominal pain, abdominal distention, acid regurgitation and （or） epigastric buring sensation, hematemesis and （or）melena （all P〉0.05 ）.The proportion of ulcer located in remnant stomach and anastomotic stoma of patients with Billroth Ⅰ gastrectomy （24.7%,18/73 and 72.6%,53/73 ）was higher than those of patients with Billroth Ⅱ gastrectomy （10.1 %,20/199 and 58.3%,116/199 ）and the difference was statistically significant （OR=2.929 and 1 .896,95 %CI ：1 .448 to 5 .927 and 1 .055 to 3.409,χ^2 =9.482 and 4.649,P =0.002 and 0.031 ）.There was no significant difference between the proportion of afferent loop and efferent loop ulcer in patients with Billroth Ⅱ gastrectomy and the proportion of duodenal ulcer in patients with Billroth Ⅰ gastrectomy （P =0.619）.The diameter of GSU of patients with BillrothⅠ（（1.1±0.7）cm）was larger than that of ulcer of patients with BillrothⅡ（（0.8±0.6）cm） and the difference was statistically significant （t = 3.591 ,P = 0.007 ）.The incidence of intestinal metaplasia and atypic hyperplasia of GSU was 8.1 % （22/272）,and there was no significant difference in gastric ulcer,stoma ulcer,nek ulcer,afferent loop and efferent loop ulcer （all P 〉0.05）.The incidence of gastric stump cancer of GSU was 4.0% （11/272）and that of gastric ulcer,stoma ulcer,nek ulcer,afferent loop and efferent loop ulcer was 13.2% （5/38 ）,2.4% （4/169 ）,1.8% （1/55 ）and 1/10,respectively.The incidence of gastric stump cancer of gastric ulcer was significantly higher than that of stoma ulcer and nek ulcer, the differences were statistically significant （OR =6.250 and 8.182,95%CI ：1.593 to 24.519 and 0.915 to 73.126,χ^2 =8.687 and 4.788,P =0.012 and 0.040）.There was no statistically significant difference in the incidence of gastric stump cancer of GSU in other gastric parts （all P 〉 0.05 ）.There was no statistically significant difference in the incidence of intestinal metaplasia,atypic hyperplasia and gastric stump cancer between case with BillrothⅠgastrectomy and case with Billroth Ⅱ gastrectomy （P =0.650 and 0.733）.Among the 11 gastric stump cancers,the number of cases with the onset time with 20 years,20-30 years and beyond 30 years after gastrectomy were one,three,seven,respectively.Conclusion The incidence of intestinal metaplasia, atypic hyperplasia and gastric stump cancer of patients with GSU was high,and the predilection site of GSU was the remnant stomach. Key words: Gastric stump ulcer; Intestinal metaplasia; Dysplasia; Gastric stump cancer