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Background   Helicobacter pylori  ( H. pylori ) infection is known to be associated with a spectrum of gastroduodenal diseases. We studied the association of  H. pylori  virulence markers cytotoxin-associated gene ( cagA ) and vacuolating associated cytotoxin gene ( vacA ) alleles in patients with non ulcer dyspepsia (NUD), gastric ulcer (GU), gastric carcinoma (GC) and duodenal ulcer (DU).    Methods   H. pylori  infection established by both rapid urease test and histology were studied. The  cagA  and  vacA  allelic status was determined by polymerase chain reaction (PCR). Sequencing of  vacA i1  and  i2  PCR product was carried out.    Results  Two hundred and twenty-four patients were included, 141 (63%) were males with a mean age of 45 ± 16, range 16-83 years. The virulence marker  cagA  was associated with GU in 20(63%) (p = 0.04), DU in 23(72%) (p = 0.003) and GC in 29(73%) (p = 0.001) compared to NUD in 51(42%).  VacA s1am1  was associated with GU in 23(72%) (p = 0.001), DU in 17(53%) (p < 0.001) and GC in 23(58%) (p = 0.003) compared to NUD in 38(32%) while  vacA s1bm1  was also associated with GU in 9(28%) (p = 0.001), DU in 12(37%) (p < 0.001) and GC 11(28%) (p < 0.001) compared to NUD in 13(11%), respectively. The diagnoses of GU in 21(66%), DU in 16(50%), GC in 20(50%) and NUD in 50(42%) were associated with moderately active chronic inflammation.  CagA  in 55(45%) (p = 0.037),  vacA s1am1  in 51(51%) (P < 0.001),  s1bm1  in 25(56%) (p = 0.002),  s1am2  32(30%) (p < 0.001) and  s1bm2  29(69%) (p = 0.004) were also associated with moderately active chronic inflammation.    Conclusion   CagA  was negative in majority of NUD patients with  H. pylori  infection. However,  cagA  was associated with peptic ulcer and GC.  VacA  allele's  s1am1  and  s1bm1  were associated with  H. pylori  associated diseases and inflammation.

Distribution of Helicobacter pylorivirulence markers in patients with gastroduodenal diseases in Pakistan