Peptic ulcer of gastrojejunal anastomosis: an undeservedly neglected problem

Abstract

Aim. To evaluate the incidence and causes of peptic ulcers of the gastrojejunal anastomosis to develop the corresponding preventive measures.Materials and Methods. We retrospectively analysed the case histories of the patients with peptic ulcer who have been admitted to our surgical unit during 1981-1996 and 2007-2021. A total of 62 patients with peptic ulcers of the anastomosis who underwent Billroth II resection were examined radiographically, endoscopically, and intraoperatively, including proteolysis and acidity measurements.Results. While the number of gastric operations has been reduced by 86%, the number of treated peptic anastomotic ulcers decreased by only 20%. The main cause of peptic ulcers was the high acidity and proteolytic activity of the gastric stump. In 22 out of 28 fully examined patients, duodenal ulcer was treated by hemiresection. The incidence of peptic ulcers of gastrojejunal anastomosis in Kemerovo in 2021 was 0.9 per 100,000 population, with 3.7 Billroth II surgeries per 100,000 population. A resection without vagotomy and insufficient acid reduction are the main causes of peptic ulcers of the gastrointestinal anastomosis, especially duodenal ulcers.Conclusion. A significant decrease in the number of distal resections of the stomach according to Billroth II over the past 25 years is not accompanied by a similar decline in the number of hospitalized patients with peptic ulcers of the gastrojejunal anastomosis.