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Gastroduodenal pathology in the light of Helicobacter pylori genotype in Egyptian patients

Context Infection with Helicobacter pylori is associated with gastroduodenal diseases such as gastritis, gastric ulcer, duodenal ulcer, gastric cancer, and mucosa-associated lymphoid tissue lymphoma. Aim The aim of this study was to detect the nature of gastroduodenal pathology in the light of the genotype of the associated H. pylori organism. Materials and methods The study was conducted on 100 patients with upper gastrointestinal tract symptoms; infection with H. pylori was detected by stool antigen test. Moreover, 20 asymptomatic patients, infected with H. pylori, were included in the study as controls. Upper gastrointestinal tract endoscopy was performed in all participants to take biopsies to diagnose the disease microscopically and to determine H. pylori virulence factors [cytotoxin-associated protein A (CagA) and VacA] by PCR. Results Patients infected by H. pylori organisms having CagA-positive genes (41 patients) developed gastritis in 53.7%, peptic ulcer disease (PUD) in 36.6%, and gastric malignancy in 9.8%. Patients infected with organisms that have VacA s1 in addition to CagA genes (19 patients) were found to have gastritis in 21.1%, PUD in 63.2%, and gastric malignancy in 15.8%. However, patients infected with H. pylori organism that have VacAs2 in addition to CagA genes (34 patients) developed gastritis in 79.4%, PUD in 20.6%, and no malignancy. Discussion The presence of VacA s1 gene in addition to CagA significantly increases the virulence of the organism toward development of PUD and gastric malignancy. The presence of VacA s2 gene significantly decreases the virulence of CagA gene to develop PUD and prevent completely its carcinogenicity.