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Background  Only a few  Helicobacter pylori -infected individuals develop severe gastric diseases and virulence factors of  H. pylori  appear to be involved in such clinical outcomes. Duodenal ulcer promoting gene A ( dupA ) is a novel virulence factor of  Helicobacter pylori  that is associated with duodenal ulcer development and reduced risk for gastric carcinoma in some populations. The aims of the present study were to determine the presence of  dupA  gene and evaluate the association among  dupA  and other virulence factors including  cagA  and  vacA  in Brazilian patients. Gastric biopsies were obtained from 205 dyspeptic patients (100 children and 105 adults). DNA was extracted and analyzed for the presence of  H. pylori  and its virulence factors using the polymerase chain reaction method.    Results  Patients with gastritis tested positive for  H. pylori  more frequently. The  dupA  gene was detected in 41.5% of them (85/205);  cagA  gene was found in 98 isolates (47.8%) and  vacA  genotype s1/m1 in 50.2%, s1/m2 in 8.3%, s2/m2 in 36.6%, s2/m1 in 0.5% and s1/s2/m1/m2 in 4.4%. We also verified a significant association between  cagA  and  dupA  genes [p = 0.0003, relative risk (RR) 1.73 and confidence interval [CI] = 1.3–2.3]. The genotypes s1/m1 were also associated with  dupA  gene (p = 0.0001, RR: 1.72 and CI: 1.3–2.2). The same associations were found when analyzing pediatric and adult groups of patients individually.    Conclusion  Ours results suggest that  dupA  is highly frequent in Brazilian patients and is associated with  cagA  gene and  vacA  s1/m1 genotype, and it may be considered an important virulence factor in the development of gastric diseases in adults or children.

Association among H. pylori virulence markers dupA, cagA and vacA in Brazilian patients