Clinical manifestations and comorbid conditions in patients with chronic gastritis according to Helicobacter pylori CagA and VacA status

Abstract

Objective — to determine the frequency of clinical manifestations and comorbidities in patients with Helicobacter pylori‑associated chronic gastritis, depending on the presence of H. pylori cytotoxin‑associated gene A and vacuolating cytotoxin A status. Materials and methods. This cross‑sectional study included 84 patients aged over 18 years with H. pylori‑associated chronic gastritis (CG). Patients were divided into two groups: 50 patients with the cytotoxin‑associated gene A (CagA) and vacuolating cytotoxin A (VacA) H. pylori strains and 34 patients with CagA‑ and VacA‑ H. pylori strains. H. pylori virulent strains (CagA+, VacA+) were detected using the polymerase chain reaction method. Solid‑phase enzyme‑linked immunosorbent assay (ELISA) was employed to detect immunoglobulins (IgA, IgG) against the CagA and VacA antigens of H. pylori. Analysis of medical records was conducted to assess clinical manifestations and the presence of comorbidities. Comorbid conditions were diagnosed using electrocardiography, abdominal ultrasound, and when necessary, computed tomography and magnetic resonance imaging, as well as videocolonoscopy. Statistical analysis was performed using the Stata 11 and Statistica 6 statistical software packages. Results. Patients with CagA+ and VacA+ H. pylori strains were more likely to have epigastric pain (60% vs. 35.3%, p=0.026) and constipation (52% vs. 20.6%, p=0.004) than patients with CagA‑ and VacA‑ H. pylori strains. Among the associated comorbid conditions in patients with H. pylori‑associated CG, the following were identified: gastroesophageal reflux disease — 33.3%, irritable bowel syndrome — 35.7%, non‑alcoholic fatty liver disease — 23.8%, autoimmune thyroiditis — 9.5%, arterial hypertension — 10.7%, and ischemic heart disease — 10.7%. The irritable bowel syndrome was significantly more prevalent in patients with CagA+ and VacA+ H. pylori strains, compared to those without CagA and VacA strains (46% vs. 20.6%, p=0.017). Other comorbid conditions occurred at similar frequencies among patients in both groups (p <0.05). Conclusions. Our study established that H. pylori virulent strains (CagA+, VacA+) could influence the clinical manifestations and associated conditions in patients with CG. Epigastric pain and constipation were more frequently observed in patients with H. pylori virulent strains (CagA+, VacA+), while the occurrence of irritable bowel syndrome was more pronounced among the associated conditions. The presence of H. pylori infection with CagA+ and VacA+ strains may be a risk factor for the development of irritable bowel syndrome. Eradication therapy could be considered as a preventive method for this comorbidity, but further research is needed to confirm this hypothesis.