Residual Antrum Syndrome refers to the anastomotic ulcer syndrome caused by incomplete resection of the gastric antrum during Billroth II surgery, resulting in residual gastric antrum. The recurrence rate of ulcers in the residual gastric antrum is 40%.

bubble_chart Etiology

The intrinsic disease cause is that the residual gastric antrum mucosa is stimulated by refluxed alkaline duodenal fluid, leading to excessive production of gastrin. This gastrin is absorbed into the bloodstream and acts on the gastric fundus mucosa, stimulating the parietal cells of the residual stomach, resulting in excessive gastric acid secretion and hyperacidity, which ultimately leads to postoperative anastomotic ulcer.

bubble_chart Clinical Manifestations

The typical symptoms include excessive gastric acid secretion and a series of symptoms caused by anastomotic ulcers, such as long-term, cyclical, hunger-related upper abdominal pain, burning sensation in the upper abdomen, acid reflux, belching, etc.

bubble_chart Diagnosis

The diagnosis can be made based on surgical history and clinical manifestations. Gastroscopy helps confirm the diagnosis, while some patients are diagnosed during reoperation.

bubble_chart Treatment Measures

The treatment involves complete resection of the residual gastric antrum and restoration of the antegrade, physiological duodenal pathway, which means converting Billroth II to Billroth I, such as performing direct end-to-end anastomosis between the stomach and duodenum or free jejunal loop replacement. Some advocate adding bilateral truncal vagotomy simultaneously.

bubble_chart Differentiation

This disease should be differentiated from Zollinger-Ellison syndrome, in which gastrin levels are elevated, typically ranging from 280 to 500 ng/L. In this syndrome, gastrin levels generally range from 30 to 176 ng/L. The insulin test can significantly reduce serum gastrin levels, aiding in differentiation.