Abstract
BackgroundThe rate of H. pylori infection in Vietnam is reportedly high, but the spectrum of H. pylori-associated gastroduodenal diseases has not been systematically investigated. Moreover, despite the similarities of ethnicity and diet, the age-standardized incidence rate of gastric cancer in the northern city of Hanoi is higher than that in the southern city of Ho Chi Minh, but the reason for this phenomenon is unknown. The virulence of Vietnamese H. pylori has also not been investigated in detail.MethodsIndividuals undergoing esophagogastroduodenoscopy were randomly recruited. H. pylori infection status was determined based on the combined results of culture, histology, immunohistochemistry, rapid urine test and serum ELISA. Peptic ulcer (PU) and gastroesophageal reflux disease was diagnosed by endoscopy, and chronic gastritis was determined histologically. H. pylori virulence factors were investigated by PCR and sequencing.ResultsAmong the examined patients, 65.6% were infected with H. pylori. The prevalence of infection was significantly higher in those over 40 years of age than in those aged ≤40. Chronic gastritis was present in all H. pylori-infected individuals, 83.1% of whom had active gastritis, and 85.3% and 14.7% had atrophy and intestinal metaplasia, respectively. PU was present in 21% of infected patients, whereas its incidence was very low in non-infected individuals. The prevalence of PU was significantly higher in Hanoi than in Ho Chi Minh. The prevalence of vacA m1, which has been identified as an independent risk factor for PU in Vietnam, was significantly higher among H. pylori isolates from Hanoi than among those from Ho Chi Minh.ConclusionsH. pylori infection is common in Vietnam and is strongly associated with PU, active gastritis, atrophy and intestinal metaplasia. vacA m1 is associated with an increased risk for PU and might contribute to the difference in the prevalence of PU and gastric cancer between Hanoi and Ho Chi Minh.
Highlights
The rate of H. pylori infection in Vietnam is reportedly high, but the spectrum of H. pylori-associated gastroduodenal diseases has not been systematically investigated
Multivariate analysis showed that the presence of Peptic ulcer (PU) was strongly associated with H. pylori infection, but not with other factors such as sex, age group, alcohol and coffee consumption, and smoking
We investigated genetic factors of H. pylori that are reportedly associated with gastroduodenal diseases, including cagA, cagE, vacA (s/m/i), babA, oipA, iceA, and homB, in 100 clinical strains (53 from Hanoi and 47 from Ho Chi Minh), of which 24 and 76 strains were isolated from patients with PU and chronic gastritis, respectively
Summary
The rate of H. pylori infection in Vietnam is reportedly high, but the spectrum of H. pylori-associated gastroduodenal diseases has not been systematically investigated. Despite the similarities of ethnicity and diet, the age-standardized incidence rate (ASR) of gastric cancer in the northern city of Hanoi is about 1.5 times higher than that in the southern city of Ho Chi Minh (27.0 vs 18.7 cases per 100.000 males and 13.2 vs 8.1 cases per 100.000 females, respectively) [13], but the reason for this intriguing phenomenon is unknown. The ASR of gastric cancer in Vietnam is approximately 3 times lower than that in Japan and Korea [13], despite the fact that the prevalence of H. pylori infection in Vietnam is reportedly higher [12] This phenomenon, regarded as an “Asian enigma”, is thought to be partly attributable to geographic variations in bacterial virulence [14,15]. We carried out the present cross-sectional study to clarify these unresolved issues
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