Abstract
The aim of this study was to investigate genetic diversity of Helicobacter pylori virulence markers to predict clinical outcome as well as to determine an antibiotic susceptibility of H. pylori strains in Poland. Gastric biopsies from 132 patients with gastrointestinal disorders were tested for presence of H. pylori with the use of rapid urease test, microbial culture, and polymerase chain reaction (PCR) detection. The genetic diversity of 62 H. pylori positive samples was evaluated by detection of cagA and PCR-typing of vacA and iceA virulence-associated genes. Most common H. pylori genotypes were cagA(+)vacAs1m2 (27.4%) and cagA(−)vacAs2m2 (24.2%). In logistic regression analysis, we recognized the subsequent significant associations: gastritis with ureC, i.e., H. pylori infection (p = 0.006), BMI index (p = 0.032); and negatively with iceA1 (p = 0.049) and peptic ulcer with cagA (p = 0.018). Thirty-five H. pylori strains were cultured and tested by E-test method showing that 49% of strains were resistant to at least one of the tested antibiotics. This is the first study that reports the high incidence and diversity of allelic combination of virulence genes in gastroduodenitis patients in Poland. Genotyping of H. pylori strains confirmed the involvement of cagA gene and vacAs1m1 genotype in development and severity of gastric disorder.
Highlights
Helicobacter pylori is an etiological factor of the most frequent and persistent bacterial infection worldwide, which affects nearly half of the world’s population
In logistic regression analysis including epidemiological factors as potential confounders, we recognized the subsequent significant associations: gastritis with ureC presence, meaning H. pylori infection, BMI index, and negatively with iceA1 presence; peptic ulcer with cytotoxin-associated gene A (cagA) presence whereas GERD with iceA1 and negatively with cagA
To avoid false negative results, it is recommended for patients not to consume the proton pump inhibitors (PPIs) two weeks before endoscopy, because these drugs indirectly interfere with H. pylori distribution in the stomach [19]
Summary
Helicobacter pylori is an etiological factor of the most frequent and persistent bacterial infection worldwide, which affects nearly half of the world’s population. In northern Europe, about 30% of adults are infected, whereas in south and east Europe the prevalence of H. pylori is often higher than 50%. The clinical outcome of H. pylori infection was supposed to be linked to certain strains differing in virulence factors presence or subtypes [5]. H. pylori is genetically heterogeneous, suggesting a lack of its clonality. It results in every H. pylori-positive subject carrying a distinct strain. This is possibly an adaptation of H. pylori to the gastric conditions of its host, as well as to the distinct patterns of the host-mediated immune response to H. pylori infection [10]
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