Helicobacter pylori and upper gastrointestinal symptoms in bronchiectasis

The recently reported increase in seroprevalence of Helicobacter pylori, th e causative pathogen in peptic ulceration, in bronchiectasis is unexplained . Therefore, the association of antibodies directed against cytotoxin-assoc iated gene A(CagA), whose expression indicates virulence of H. pylori, and upper gastrointestinal symptoms in patients with stable bronchiectasis and healthy volunteers evaluated. One hundred patients (mean+/-SD age 55.1+/-16.7 yrs) and 94 healthy asympto matic subjects (54.6+/-7.6 yrs) underwent clinical and physiological assess ment and serum levels of anti-H. pylori CagA were determined using standard clinical and enzyme-linked immunosorbent assay techniques. Samples were positive for anti-H. pylori CagA in 11.7% of controls and 24% of bronchiectatic subjects (p=0.03). There was, however, no association bet ween serum H. pylori CagA immunoglobulin G level and forced expiratory volu me in one second (FEV1), forced vital capacity (FVC), sputum volume, respir atory symptoms or upper respiratory gastrointestinal symptoms (p>0.05). Pat ients who suffered from acid regurgitation or upper abdominal distension ha d significantly lower FEV1 and FVC (as a percentage of the predicted value) compared to their counterparts. The results of anticytotoxin-associated gene A measurements in this study c ontrasted with the previous finding that anti-Helicobacter pylori immunoglo bulin G correlated with sputum volume. These findings, therefore, suggest t hat Helicobacter pylori, should it have a pathogenic role in bronchiectasis , could act via noncytotoxin-associated gene A-mediated mechanisms, and, in this context, gastro-oesophageal reflux might be of importance in bronchie ctasis.