Genotypically distinct Helicobacter pylori causes Gastric and Peptic Ulcer diseases in Kashmir Indian patients

Abstract

BackgroundAlthough 50% of the world population is infected, only a small fraction of people infected with H. pylori suffers from active gastrointestinal (GI) diseases such as gastric ulcer, peptic ulcer and gastric cancer. Genotypically varying virulent H. pylori such as cytotoxin associated gene (Cag A) and vaculating assoctiated cytotoxin (VacA) have been shown associated with gastric and duodenal ulcer patients living in different countries, respectively. Significant Kashmir population has been identified to have GI diseases. However, it is not known whether Kashmir patients with gastric and peptic ulcer diseases are infected with different or same virulent H. pylori.AimThis study was initiated to identify whether patients with gastric and peptic ulcers, and gastric cancer are infected with same or different H. pylori genotypes.Methods263 patients scheduled for upper endoscopy and 50 healthy volunteers were recruited for this study. Endoscopy examination divided the patients into non‐ulcer Dyspepsia (NUD), Peptic ulcer Disease (PUD) and Gastric cancer (GC). Biopsy specimens were taken from stomach (antrum and fundus) and duodenum from each patient. H. Pylori infection was confirmed by Rapid urease test (RUT), glm ureC and culture. H. pylori genomic DNA was isolated from H. pylori culture and biopsy specimen using phenol chloroform method. CagA and VacA genotypes were confirmed by polymerase chain reaction (PCR). H. pylori antigen was detected by immunohistochemistry.ResultsEndoscopic examination grouped the 213 patients into NUD (65), PUD (50) and GC (98). glm ureC analyses established 69%, 80% and 65% of NUD, PUD and GC patients were H. pylori positive, respectively. PCR analysis revealed that: 1) 78%, 80% and 75% of the NUD, PUD and GC patients were infected with CagA positive strains of H. Pylori, respectively; and 2) 76%, 85% and 80% of the NUD, PUD and GC patients were infected with VacA positive strains of H. pylori, respectively. Of the 50 normal healthy volunteers 15 (30%) were also identified H. pylori positive.ConclusionThe most virulent genotype VacA is significantly over‐expressed in all the disease groups indicating a strong association of this genotype with H. pylori ‐ associated disease pathogenesis. Age distribution of different gastro‐duodenal disease groups in JK and Delhi region. Region NUD PUD GC Normal p value JK 38.8±8.7 (n=65) 44.1±12.6 (n=50) 52.9±11.95 (n=98) 46.94±9.42 (n=50) 0.07a<0.001b<0.001b Delhi 38.1±9.6 (n=55) 43.7±11.5 (n=62) 48.3±12.9 (n=50) 36.1±11.7 (n=50) 0.05a<0.00 lb<0.22c NUD‐ non ulcer dyspepsia; PUD‐peptic ulcer disease; GC‐gastric cancer; JK – Jammu and Kashmir. p value for NUD vs. PUD, NUD vs. GC; and PUP vs. GC