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Background  Individuals can be infected with multiple strains of  Helicobacter pylori . However, the differences among co-infecting strains have not been well analyzed yet. This study aimed to investigate whether the virulence factors and antibiotic resistance patterns of  H. pylori  differ between strains isolated from different locations of the stomach in the same patient.    Methods   H. pylori  isolates were obtained from the antrum and body of the stomach. Genetic differences were examined by random amplified polymorphic DNA (RAPD) fingerprinting. Antibiotic resistance was assessed using the agar dilution method. Virulence factors were identified by polymerase chain reaction and DNA sequencing.    Results  Among 80 patients, co-infection by two  H. pylori  strains was detected in 10 patients. Among the 10 pairs of  H. pylori  strains, differences in antibiotic resistance patterns were detected in 7 pairs (clarithromycin, 1 patient; quinolone, 3 patients; metronidazole, 4 patients) and differences in virulence factors were detected in 5 pairs. The  cagA  virulence gene was detected in all 10 patients, and 2 patients had  H. pylori  strains with different EPIYA motifs. Differences in  vacA  genotypes were detected in 4 patients.    Conclusions  Co-infection by two  H. pylori  strains was confirmed by RAPD fingerprinting. Frequently, two  H. pylori  strains obtained from a single host differed in their virulence factors and antibiotic resistance patterns. Co-infection by multiple  H. pylori  strains could undermine the success of eradication therapy and should be considered when interpreting the results of antimicrobial susceptibility tests.    Electronic supplementary material  The online version of this article (10.1186/s12876-019-1062-5) contains supplementary material, which is available to authorized users.

The analysis of virulence factors and antibiotic resistance between Helicobacter pylori strains isolated from gastric antrum and body