Abstracts
1999 Digestive Disease Week

# 2189 GASTRIC OUTLET OBSTRUCTION RESULTING FROM PEPTIC ULCER DISEASE REQUIRING SURGICAL RESECTION IS INFREQUENTLY ASSOCIATED WITH HELICOBACTER PYLORI
Jeff Gibson, Univ of Tenn, Memphis, Memphis, TN; S W Behrman, T C Fabian, Univ of Tennessee, Memphis, TN

Gastric outlet obstruction (GOO) requiring therapeutic intervention remains a common problem. The incidence of H. pylori in this cohort has not been well defined. Pneumatic dilatation (PD) has been proposed as first line therapy prior to surgical resection. If H. pylori infection in those with GOO is infrequent, PD may not offer permanent control without the need for long term antacid therapy. The purpose of this study is to examine the incidence of H. pylori infection and surgical outcome in those undergoing resection for GOO. Methods: The records of all patients resected (vagotomy and antrectomy) from 1993-98 for GOO at three hospitals in a university teaching program were reviewed. Smoking history, nonsteroidal use, weight loss, prior ulcer treatment and prior attempts at PD were among factors examined. H. pylori infection was documented by Steiner stain from either preoperative biopsy or final surgical specimens. Surgical complications and patient satisfaction were ascertained from inpatient records, postoperative clinic notes and where possible, follow-up phone survey. Results: Sixteen patients underwent surgical resection during the study period (8% of all partial gastrectomies identified). There were 9 males and 7 females with a mean age of 60 (range 40-82). Only 38% percent used tobacco and 19% used nonsteoidal medication on a chronic basis. Eighty-one percent of patients were taking antacids prior to presentation. Fifty-six percent reported weight loss averaging 24 pounds. Four of 16 had prior attempts at PD, 3 of whom were H. pylori negative. All four had further weight loss following these failed attempts. Of the 16 patients reviewed, only 6 (37.5%) were H. pylori positive. There was no procedure related mortality and all patients expressed satisfaction with surgical outcome. Conclusions: 1) In this cohort, H. pylori inection is present in the minority, 2) prior attempts at PD were unsuccessful which may be related to the H. pylori negative status of these patients, 3) mortality was zero, and patient satisfaction uniformly positive following surgical resection and 4) patient's with H.pylori negative GOO associated with peptic ulcer disease should be strongly considered for an early, definitive, acid reducing surgical procedure.

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