Relationship between Helicobacter pylori iceA, cagA, and vacA status and clinical outcome: Studies in four different countries

There is continuing interest in identifying Helicobacter pylori virulence f actors that might predict the risk for symptomatic clinical outcomes. It ha s been proposed that iceA and cagA genes are such markers and can identify patients with peptic ulcers. We compared H. pylori isolates from four count ries, looking at the cagA and vacA. genotypes, iceA alleles, and presentati on of the infection. We used PCR to examine iceA, vacA, and cagA status of 424 H. pylori isolates obtained from patients with different clinical prese ntations (peptic ulcer, gastric cancer, and atrophic gastritis), The H, pyl ori isolates examined included 107 strains from Bogota, Colombia, 70 from H ouston, Tex,, 135 from Seoul, Korea, and 112 from Kyoto, Japan. The predomi nant genotype differed among countries: the cagA-positive iceA1 vacA slc-ml genotype was predominant in Japan and Korea, the cagA-positive iceA2 vacA s1b-m1 genotype nas predominant in the United States, and the cagA-positive iceA2, vacA sla-ml genotype was predominant in Colombia, There was no asso ciation between the iceA, vacA, or cagA status and clinical outcome in pati ents in the countries studied. iceA status shows considerable geographic di fferences, and neither iceA nor combinations of iceA, vacA, and cagA were h elpful in predicting the clinical presentation of an H. pylori infection.