Helicobacter pylori infection and gastroduodenal diseases in Vietnam: a cross-sectional, hospital-based study

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Abstract

Background

The rate of H. pylori infection in Vietnam is reportedly high, but the spectrum of H. pylori-associated gastroduodenal diseases has not been systematically investigated. Moreover, despite the similarities of ethnicity and diet, the age-standardized incidence rate of gastric cancer in the northern city of Hanoi is higher than that in the southern city of Ho Chi Minh, but the reason for this phenomenon is unknown. The virulence of Vietnamese H. pylori has also not been investigated in detail.

Methods

Individuals undergoing esophagogastroduodenoscopy were randomly recruited. H. pylori infection status was determined based on the combined results of culture, histology, immunohistochemistry, rapid urine test and serum ELISA. Peptic ulcer (PU) and gastroesophageal reflux disease was diagnosed by endoscopy, and chronic gastritis was determined histologically. H. pylori virulence factors were investigated by PCR and sequencing.

Results

Among the examined patients, 65.6% were infected with H. pylori. The prevalence of infection was significantly higher in those over 40 years of age than in those aged ≤40. Chronic gastritis was present in all H. pylori-infected individuals, 83.1% of whom had active gastritis, and 85.3% and 14.7% had atrophy and intestinal metaplasia, respectively. PU was present in 21% of infected patients, whereas its incidence was very low in non-infected individuals. The prevalence of PU was significantly higher in Hanoi than in Ho Chi Minh. The prevalence of vacA m1, which has been identified as an independent risk factor for PU in Vietnam, was significantly higher among H. pylori isolates from Hanoi than among those from Ho Chi Minh.

Conclusions

H. pylori infection is common in Vietnam and is strongly associated with PU, active gastritis, atrophy and intestinal metaplasia. vacA m1 is associated with an increased risk for PU and might contribute to the difference in the prevalence of PU and gastric cancer between Hanoi and Ho Chi Minh.

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Most cited references 19

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Helicobacter pylori infection.

Sebastian Suerbaum, Pierre Michetti (2002)

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Clinical relevance of the Helicobacter pylori gene for blood-group antigen-binding adhesin.

R Rad, M Gerhard, Joerg C. Prinz … (1999)

Infection with Helicobacter pylori is associated with different human gastric diseases. Biochemical studies, in vitro adherence assays, and in vivo animal models revealed that epithelial attachment of H. pylori can be mediated by the blood-group antigen-binding adhesin (BabA) targeting human Lewis(b) surface epitopes. Studies with transgenic mice expressing the Lewis(b) epitope have shown that such attachment can alter disease outcome. In the current study, the presence of the babA2 gene encoding the adhesin was investigated in clinical isolates from a German population by using PCR and reverse transcription-PCR. A positive genotype was correlated to allelic variations in the genes encoding VacA and CagA and also to the prevalence of duodenal ulcer, distal gastric adenocarcinoma, mucosa-associated lymphoid tissue lymphoma, and antral gastritis. The presence of babA2 was significantly associated with duodenal ulcer (P = 0.0002) and adenocarcinoma (P = 0.033). In contrast, type 1 strains (vacAs1- and cagA-positive) were associated with only duodenal ulcer (P = 0.004) but not adenocarcinoma (P = 0.235). Genotype presence of babA2, vacAs1, and cagA ("triple-positive" strains) showed a highly significant correlation to the prevalence of ulcer (P = 0.000002) and adenocarcinoma (P = 0.014) and discriminated significantly better between disease outcome than did the current type 1 classification. These results indicate that the babA2 gene is of high clinical relevance and would be a useful marker to identify patients who are at higher risk for specific H. pylori-related diseases.

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Clinical relevance of Helicobacter pylori cagA and vacA gene polymorphisms.

Daniela Basso, Carlo-Federico Zambon, Darren P Letley … (2008)

The Helicobacter pylori gene cagA and s1 or m1 forms of vacA are more common in disease-associated strains. Recently, forms of cagA encoding multiple type C EPIYA segments (which increase phosphorylation-dependent CagA activity) and a new type i1 "intermediate region" polymorphism in vacA (which confers toxicity) have been described. We assessed the association of new and established cagA and vacA polymorphisms with disease. We studied 203 H pylori-infected subjects (53 gastric cancer [GC], 52 peptic ulcer [PU], and 98 gastritis). vacA signal, mid and intermediate region polymorphisms, cagA presence, and EPIYA-C segment number were analyzed by polymerase chain reaction. cagA-positive strains were significantly associated with GC and PU (P < .001 and P < .05). GC risk was further associated with the number of cagA EPIYA-C segments (odds ratio [OR] = 7.37, 95% confidence interval [CI] = 1.98-27.48 for 1 EPIYA-C segment; OR = 32.5, 95% CI = 8.41-125.58 for 2 or more EPIYA-C segments). Increasing number of EPIYA-C segments also increased the risk of intestinal metaplasia. Type s1 and i1 vacA alleles were also associated with GC and type i1 vacA with PU (OR = 2.58, 95% CI = 1.19-5.61), including a significant association with duodenal ulcer. In multivariate analysis, the associations of cagA EPIYA-C segment number with GC and intestinal metaplasia as well as vacA i1 type association with PU remained. We confirmed the associations of cagA and vacA polymorphisms with disease but now define their most important features. For cancer risk, among Western strains, the most important factor is the number of cagA EPIYA-C segment. For PU risk, it is the intermediate region type of vacA.

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Author and article information

Journal

Journal ID (nlm-ta): BMC Gastroenterol

Title: BMC Gastroenterology

Publisher: BioMed Central

ISSN (Electronic): 1471-230X

Publication date Collection: 2010

Publication date (Electronic): 30 September 2010

Volume: 10

Page: 114

Affiliations

[1 ]Department of Molecular Pathology, Faculty of Medicine, Oita University, Yufu City (879-5593), Oita Prefecture, Japan

[2 ]Department of Gastroenterology, Faculty of Medicine, Oita University, Yufu City (879-5593), Oita Prefecture, Japan

[3 ]Department of Human Environmental and Social Medicine, Faculty of Medicine, Oita University, Yufu City (879-5593), Oita Prefecture, Japan

[4 ]Department of Pathology, 108 Hospital, No.1 Tran Hung Dao Street, Hanoi City, Vietnam

[5 ]Department of Gastroenterology, 108 Hospital, No.1 Tran Hung Dao Street, Hanoi City, Vietnam

[6 ]Department of Molecular Biology, 108 Hospital, No.1 Tran Hung Dao Street, Hanoi City, Vietnam

[7 ]Department of Endoscopy, Cho Ray Hospital, No.201B Nguyen Chi Thanh Street, Ho Chi Minh City, Vietnam

[8 ]Department of Training and Research, Cho Ray Hospital, No.201B Nguyen Chi Thanh Street, Ho Chi Minh City, Vietnam

[9 ]Department of Gastrointestinal Endoscopy, Tama-Nagayama Hospital, Nippon Medical School, Tokyo (113-8602), Japan

[10 ]Department of Environmental and Preventive Medicine, Faculty of Medicine, Oita University, Yufu City (879-5593), Oita Prefecture, Japan

Article

Publisher ID: 1471-230X-10-114

DOI: 10.1186/1471-230X-10-114

PMC ID: 2959090

PubMed ID: 20920280

SO-VID: 72bd75c6-7cd0-485b-b393-58c460445581

License:

This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Helicobacter pylori infection and gastroduodenal diseases in Vietnam: a cross-sectional, hospital-based study

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Abstract

Background

Methods

Results

Conclusions

Related collections

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Most cited references 19

Helicobacter pylori infection.

Clinical relevance of the Helicobacter pylori gene for blood-group antigen-binding adhesin.

Clinical relevance of Helicobacter pylori cagA and vacA gene polymorphisms.

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