Clinical relevance of Helicobacter pylori Cag-A positive strains: gastroduodenal peptic lesions marker

OBJECTIVES: peptic ulcer is characterized by its recurrent nature, which ne cessitates maintenance treatment in most patients. But this natural history can be changed in patients with peptic ulcer associated Is Helicobacter py lori, as shown by the low rates of recurrence and decreased hemorrhagic rec idivism associated with this infection, Whether CagA or VacA strains are as sociated with a greater risk of peptic ulcer is controversial. This study w as designed to examine endoscopic findings and their relation with H. pylor i phenotype (CagA or VacA). METHODS: 106 selected dyspeptic patients underwent upper gastrointestinal t ract endoscopic examination between September 1996 and May 1997 [69 with H. pylori (Hp) and 37 without this infection]. Endoscopic findings were class ified as gastric ulcer (GU), duodenal ulcer (DU), gastric erosions (GE), du odenitis (Du), chronic gastritis (CG) and normal mucosa (NM). Hp phenotype was analyzed with a western blot test. RESULTS: 75% of H. pylori strains were CagA-positive and 54.2% were VacA-po sitive. 82.4% of the cases of DU were associated with a CagA+ phenotype, bu t the association was not statistically significant. Otherwise 100% of gast ric ulcers were associated with CagA+ strains (p < 0.005). VacA phenotype w as not associated with any particular endoscopic finding. Peptic ulcer (DU or GU) was also associated with the CagA+ phenotype (p < 0.05). CONCLUSIONS: the CagA+ H, pylori phenotype seems to be a peptic lesion mark er, but was more frequently related with GU than with DU in our sample of S panish patients.