Anticuerpos frente a la citotoxina CagA de Helicobacter pylori en diversas enfermedades gastroduodenales en dos poblaciones diferentes

Abstract

We aimed at studying the prevalence of infection by H. pylori along with the CagA status of the strain in two populations (Spain and Cuba) and the relationship with several gastroduodenal lesions. We also studied the role of the test-and-scope strategy in the decrease of unnecessary gastroscopies. 100 dyspeptic patients from Spain and 100 from Cuba were included. At endoscopy, antrum biopsies were obtained and H. pylori status was evaluated by rapid urease test. CagA status of the strain was assessed by Western Blot. The test-and-scope strategy was evaluated according to H. pylori infection and CagA status. Mean age of Spanish and Cuban patients was 45 (16) and 46 (15) years, respectively. Dyspeptic symptoms were similar in both groups. Prevalence of infection by H. pylori was higher in Cuban (73%) than in Spaniards (40%) (p < 0.01). Prevalence of CagA+ strains was also higher in Cuban (81 vs. 27%) (p < 0.01). Among CagA+ Spanish patients, 11% had a duodenal ulcer, whereas this lesion was not found in any CagA patient (p < 0.05). Duodenal ulcer prevalence in CagA+ and CagA Cuban patients was 31 and 0%, respectively (p < 0.05). The test-and-scope strategy would have avoided endoscopy in only 24% Spanish and 15% Cuban patients. The prevalence of H. pylori infection is higher in Cuban than in Spanish dyspeptic patients. H. pylori strains of Cuba seem to be more virulent than those of Spain. CagA protein is a marker of peptic ulcer in both populations. These differences could partly explain the variations in the prevalence of different gastroduodenal disorders between both countries. The test-and-scope strategy appears to avoid a low number of endoscopies.