ASSOCIATION OF CAGA-POSITIVE AND CAGA-NEGATIVE HELICOBACTER-PYLORI STRAINS WITH PATIENTS SYMPTOMS AND GASTRITIS IN PRIMARY-CARE PATIENTS WITH FUNCTIONAL UPPER ABDOMINAL COMPLAINTS

Background: CagA-positive Helicobacter pylori strains have been report ed to be associated with peptic ulcer or malignancy more often than ca gA-negative strains. Less is known about the relation of H. pylori ser ology (CagA-negative or CagA-positive) to histologic changes in the st omach of patients with functional upper abdominal complaints. The asso ciation of H. pylori status with patient symptoms or with different su bgroups of non-organic dyspepsia is also obscure. In the present study patients' symptoms and their relation to H. pylori serology (H. pylor i-negative, H. pylori-positive but CagA-negative, and H. pylori-positi ve and CagA-positive) were evaluated in general practice patients who had functional upper abdominal complaints. The association of H. pylor i serology with different symptom-based subgroups of functional upper abdominal complaints was also assessed. The severity and activity of i nflammation and the presence of atrophy and intestinal metaplasia in t he antrum and body were evaluated and compared with H. pylori status. Methods: Four hundred consecutive unselected dyspeptic patients in pri mary care were investigated by means of gastroscopy, upper abdominal u ltrasound, laboratory screening including H. pylori and CagA serology, and other examinations if needed. Of these patients 193 with function al upper abdominal complaints were enrolled in this study. Results: Of the study patients 87 (45%) were H. pylori-negative, 70 (36%) were H. pylori- and CagA-positive, and 36 (19%) were H. pylori-positive but C agA-negative. There were no differences in the occurrence of any dyspe ptic symptoms between H. pylori-related subgroups. Nor was there an as sociation between H. pylori status and symptom-based subgroups in our study patients. Inflammation of the stomach was related to H. pylori i nfection, but CagA-seropositive patients did not have moderate or seve re inflammation more often than CagA-seronegative ones. CagA-seroposit ive patients with functional upper abdominal complaints did not have a trophic changes or intestinal metaplasia in the stomach more often tha n those who were CagA-negative. Conclusions: H. pylori or more specifi c CagA serology is not associated with any specific symptom profile of dyspepsia or with any symptom-based subgroups in patients with functi onal upper abdominal complaints in primary care. The study patients wi th CagA seropositivity did not have more severe histologic changes in the stomach than the patients who were H. pylori-seropositive but CagA -seronegative.