Role of Helicobacter pylori cagA(+) strains and specific host immune responses on the development of premalignant and malignant lesions in the gastric cardia

The incidence rates of gastric cardia and esophageal adenocarcinomas are in creasing, but data suggest that carriage of cagA(+) Helicobacter pylori str ains may protect against development of Barrett's esophagus and esophageal adenocarcinoma. Our aims were to examine the relationship between pre-malig nant and malignant lesions in the gastric cardia and serum antibodies to H, pylori antigens in patients with and without complications of Barrett's es ophagus. The prevalence of carditis was 40% in controls compared with 13% i n patients with complicated or uncomplicated Barrett's esophagus and cardia adenocarcinoma (p < 0.001), Cardia intestinal metaplasia (IM) and atrophy were present and concordant in 28% of controls but less frequent in patient s with Barrett's alone or with dysplasia/adenocarcinoma (0% for each, p < 0 .001). Carriage of cagA(+) strains was present in 34% of patients with card itis and significantly associated with increased frequency and severity of cardia inflammation, IM, and atrophy but not with adenocarcinoma, IgA and H spA seropositivity were significantly increased in H. pylori-colonized pati ents with carditis compared to persons with normal cardia histology (p less than or equal to 0.005) but not in persons with esophageal disease or card ia adenocarcinoma. We conclude that carriage of cagA(+) H. pylori strains a nd induction of particular serological responses are significantly associat ed with marked histological findings in the gastric cardia but: not with ad enocarcinoma of either the gastric cardia or esophagus. (C) 1999 Wiley-Liss , Inc.