Correlates of infection with Helicobacter pylori positive and negative cytotoxin-associated gene A phenotypes among Arab and Jewish residents of Jerusalem.

K Muhsen,W Abu Ahmed,G Beer-Davidson,J D Kark,D Cohen,H Nassar,R Sinnereich

doi:10.1017/s0950268819001456

Abstract

We examined the prevalence and correlates of Helicobacter pylori (H. pylori) infection according to cytotoxin-associated gene A (CagA) phenotype, a main virulence antigen, among the ethnically diverse population groups of Jerusalem. A cross-sectional study was undertaken in Arab (N = 959) and Jewish (N = 692) adults, randomly selected from Israel's national population registry in age-sex and population strata. Sera were tested for H. pylori immunoglobulin G (IgG) antibodies. Positive samples were tested for virulence IgG antibodies to recombinant CagA protein, by enzyme-linked immunosorbent assay. Multinomial regression models were fitted to examine associations of sociodemographic factors with H. pylori phenotypes. H. pylori IgG antibody sero-prevalence was 83.3% (95% confidence interval (CI) 80.0%-85.5%) and 61.4% (95% CI 57.7%-65.0%) among Arabs and Jews, respectively. Among H. pylori positives, the respective CagA IgG antibody sero-positivity was 42.3% (95% CI 38.9%-45.8%) and 32.5% (95% CI 28.2%-37.1%). Among Jews, being born in the Former Soviet Union, the Middle East and North Africa, vs. Israel and the Americas, was positively associated with CagA sero-positivity. In both populations, sibship size was positively associated with both CagA positive and negative phenotypes; and education was inversely associated. In conclusion, CagA positive and negative infection had similar correlates, suggesting shared sources of these two H. pylori phenotypes.

Highlights

The bacterium Helicobacter pylori (H. pylori) colonises the stomach and causes persistent infection [1]
Sera from 692 Jewish and 959 Arab participants were available for H. pylori immunoglobulin G (IgG) testing
The main finding of this assessment is the differential prevalence of H. pylori phenotype between adult Arabs and Jews living in the same city

Summary

Introduction

The bacterium Helicobacter pylori (H. pylori) colonises the stomach and causes persistent infection [1]. H. pylori infection is highly prevalent in developing countries, reaching 90% in adults, as compared with 20%–50% in developed countries [1] In the latter, the prevalence of H. pylori infection is high among immigrants from endemic regions, and in ethnic groups of low socioeconomic status [2,3,4,5,6]. Infection with H. pylori CagA positive strains is associated with increased risk for peptic ulcer disease, premalignant gastric lesions and gastric cancer [10, 12]. Understanding the correlates of H. pylori infection according to CagA phenotype is important for prevention of gastric cancer It is not clear whether there are specific risk factors for H. pylori phenotypes, Downloaded from https://www.cambridge.org/core.

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