CLINICAL RELEVANCE OF THE CAGA, VACA, AND ICEA STATUS OF HELICOBACTER-PYLORI

Background & Aims: Clinical outcome of Helicobacter pylori infection m ay be associated with specific virulence-associated bacterial genotype s. The aim of this study was to assess the relationships between H. py lori cagA, vacA, and iceA status and severity of disease. Methods: Gas tric biopsy specimens from 94 patients in The Netherlands were analyze d by polymerase chain reaction and reverse hybridization. Results: cag A was present in 63 (67%) of 94 cases and was associated with peptic u lcer disease (P = 0.0019). vacA genotypes s1a/m1, s1a/m2, s1b/m1, s1b/ m2, and s2/m2 were found in 36.2%, 23.4%, 2.1%, 5.3%, and 20.2%, respe ctively. Ten isolates (10.6%) contained multiple vacA genotypes. The p resence of peptic ulcers was associated with type sl strains (P = 0.00 06) but not with the m type (P = 0.2035). cagA and vacA s1 were strong ly associated (P < 10(-5)). iceA1 was found in 53 (56.4%) and iceA2 in 25 (26.6%) of the 94 cases. In 14 isolates (14.9%), both iceA alleles were found, and 2 (2.1%) were negative for both iceA1 and iceA2. iceA 1 was also associated with peptic ulcer disease (P = 0.0042). The iceA allelic type was independent of the cagA and vacA status. Conclusions : vacA s1, cagA, and iceA1 are markers of H. pylori strains that are m ore likely to lead to ulcer disease.