Mortality among patients with partial gastrectomy for benign ulcer disease

Abstract

Partial gastrectomy for benign ulcer disease may influence future risk of death, eg, through changes in life-style or metabolism. To reveal such possible long-term effects, we analyzed a population-based cohort of 6459 patients operated on from 1950 through 1958 and followed through 1985. We found a lower overall mortality than in the general Swedish population (standardized mortality ratio = 0.94; 95% confidence interval 0.91-0.97). Mortality was decreased among those with duodenal ulcers, Billroth II operations, and older age at operation but increased as time passed after operation. Mortality was significantly (P < 0.05) increased from tuberculosis, alcoholism, emphysema, stomach ulcer, intestinal obstruction, gallbladder or biliary disease, suicide, and accidental falls but decreased from ischemic heart disease and cerebrovascular disease. Preoperative selection of healthy patients and the probable increased prevalence of risk factors for ulcer disease (smoking, alcoholism, and lower socioeconomic status) in this cohort explain most of these findings. Apart from intestinal obstruction, gallbladder or biliary tract diseases, and tuberculosis, the surgical procedure did not appear to increase mortality beyond one year after operation.

Tuberculosis associated with gastrectomy

“…In other countries, older populations have a high prevalence of gastrectomy as a condition concomitant with tuberculosis. 10,11 Many of our patients had old tuberculous lesions detected by chest roentgenogram. These patients were likely to develop reactivation of tuberculosis because of decreased cellular immunity arising from aging, malnutrition, diabetes mellitus, and gastrectomy.…”

“…[7][8][9] Mortality was significantly increased by tuberculosis and other complications after partial gastrectomy for benign ulcer disease. 10 The prevalence of tuberculosis after gastrectomy is higher than it is in the general population or in age-matched healthy subjects. 1,3,4 The incidences of both gastric ulcer and gastric cancer are high in Japan, so the prevalence of gastrectomy is also high.…”

“…Malnutrition is one of the main risk factors in the development of tuberculosis; 10,11 IGT is also considered a factor. Although there was no comparison with valid controls (ageand sex-matched nontuberculous patients) in the present study, we consider that the patients with tuberculosis plus gastrectomy had clinical and laboratory features that suggested malnutrition.…”

Gastrectomy is a Risk Factor for Alcoholism.

“…Weobserved a higher percentage of gastrectomy in alcoholics (16.5%) and a high incidence of development of alcoholism after gastrectomy (55 out of 72 gastrectomized alcoholics). From the standpoint of surgeons, the developmentof alcoholism was also reported as a cause of increased mortality after the gastrectomy (2). The mechanismfor the development of post-gastrectomy alcoholism may involve the loss of gastric first pass metabolism ofethanol followed by a quick passage ofethanol into the small intestine, resulting in massive entry of ethanol into systemic circulation and the induction of alcohol tolerance and dependence (3,4).…”

Respiratory Diseases and <i>Helicobacter pylori</i> Infection: Is There a Link?

“…Moreover, active pulmonary tuberculosis (TB) is frequent among patients with partial gastrectomy for peptic ulcer disease [16]. Finally, the prevalence of chronic bronchitis in peptic ulcer patients is increased two- to three-fold compared with findings in ulcer-free controls [17].…”