CagA status in dyspeptic patients with and without peptic ulcer disease inTurkey: Association with histopathologic findings

Background. CagA seropositivity is closely associated with that of vacuolat ing cytotoxin (VacA). Helicobacter pylori strains positive for both VacA an d CagA were reported to be strongly associated with peptic ulcer disease. D ifferent results reporting that cagA gene is not associated with more serio us diseases, lowers the importance of CagA protein as a marker. In this stu dy, CagA seropositivity is examined in Turkish peptic ulcer and nonulcer dy spepsia patients; histopathologic scores of CagA (+) and CagA (-) groups we re compared. Materials and Methods. Sixty consecutive patients (one gastric ulcer, 13 du odenal ulcer and 46 nonulcer dyspepsia) (mean age 40.9 +/- 14.7; 33 women, 27 men) with dyspeptic complaints who underwent upper gastrointestinal (GI) endoscopy were included. Biopsies from the antrum and corpus were used for histopathologic examination and for rapid urease test. H. pylori-negative patients comprised the control group. Histopathologic findings were graded using a previously described grading system (for inflammation, activity atr ophy, intestinal metaplasia and H. pylori, grades from 0 to 3 were used to quantify the findings). In H. pylori-positive patients, antibodies against CagA protein were determined using an ELISA method. Results. H. pylori was (+) in 46 patients. One duodenal ulcer and 13 nonulc er dyspepsia patients were negative for H. pylori. CagA positivity is signi ficantly higher in peptic ulcer patients [12/12] than in nonulcer dyspepsia patients [25/33]. While inflammation, activity and atrophy scores were sig nificantly higher in CagA positive patients, intestinal metaplasia and H. p ylori load scores were not. Although the histopathologic scores in controls were lower than CagA (-) group, statistical significance was observed only in inflammation and intestinal metaplasia scores. Conclusion. Development of more prominent gastritis and severe atrophy in C agA (+) patients is an indicator of the importance of CagA rather than H. p ylori load. Therefore, we suggest that nonulcer dyspepsia patients should a lso be tested for CagA status along with the tests for H. pylori status; an d a positive CagA testing should be considered as an indication for eradica tion treatment. If CagA is negative, further assessment should be performed to decide whether or not to treat the patient.