ENDER SERİN, FAZİLET KAYASELÇUK, FATİH KOKSAL, BİROL ÖZER, YÜKSEL GÜMÜRDÜLÜ, SEDAT BOYACIOĞLU
Annals of Medical Sciences - 2003;12(3):72-78
Background: The link between CagA+ Helicobacter pylori strains and more severe gastritis is not consistent throughout the world. Our aims were to study the features of infection with H. pylori CagA+ strains, and to assess how these strains relate to severity of gastric and duodenal pathology in a group of Turkish patients. Materials and Methods: Mucosal biopsies of the duodenal bulb and the gastric antrum, corpus, and cardia of 29 patients with positive H. pylori cultures were semiquantitative assessed for inflammation, bacterial density, epithelial proliferation (Ki-67 expression), and p53 expression. CagA was tested with polymerase chain reaction. Results: The highest frequencies of H. pylori, inflammation, Ki-67, and p53 expression were observed in the antrum, followed by the cardia, fundus, and corpus, respectively. Density of H. pylori was positively correlated with the degree of inflammation and with p53 overexpression in all gastric regions. The frequency of CagA+ H. pylori status in patients with duodenal ulcers was 67%, whereas the figure in non-ulcer patients was 30% (p=0.07). Bulbar inflammation was significantly correlated with CagA status (r=0.48; p<0.01). There were no significant associations between CagA positivity and gastric inflammation, H. pylori density, or epithelial proliferation. Logistic regression analysis did not identify any histologic parameter or H. pylori strain as an independent predictor of duodenal ulcer. Conclusion: The density of H. pylori, regardless of CagA status, is the most important predictor of inflammatory and proliferative reaction to gastric mucosal infection. Ulcer development in the bulbus may be related to bulbar inflammation, which is enhanced by CagA+ strains which did not show significant effect on gastric pathology in Turkish patients.
