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Background  Almost all  Helicobacter pylori  infected person develop gastritis and severe gastritis is supposed to be the denominator of peptic ulcer diseases, which may lead to gastric cancer. However, it is still an enigma why few strains are associated with ulcer formation, while others are not related with any disease outcome. Although a number of putative virulence factors have been reported for  H. pylori , there are contradictory results regarding their connotation with diseases. Recently, there has been a significant attention in strain-specific genes outside the  cag  pathogenicity island, especially genes within plasticity regions. Studies demonstrated that certain genes in this region may play important roles in the pathogenesis of  H. pylori -associated diseases. The aim of this study was to assess the role of selected genes ( jhp0940 ,  jhp0945 ,  jhp0947  and  jhp0949 ) in the plasticity region in relation to risk of  H. pylori -related diseases in Indian population.    Methods  A total of 113  H. pylori  strains isolated from duodenal ulcer (DU) (n = 61) and non-ulcer dyspepsia (NUD) subjects (n = 52) were screened by PCR and Dot-Blot to determine the presence of these genes. The comparative study of IL-8 production and apoptosis were also done by co-culturing the AGS cells with  H. pylori  strains of different genotype.    Results  PCR and Dot-Blot results indicated that the prevalence rates of  jhp0940 ,  jhp0945 ,  jhp0947  and  jhp0949  in the  H. pylori  strains were 9.8, 47.5, 50.8, 40.9 % and 17.3, 28.8, 26.9, 19.2 % isolated from DU and NUD, respectively. IL-8 production and apoptotic cell death were significantly higher in  H. pylori  strains containing  jhp0945 ,  jhp0947  and  jhp0949  than the strains lacking those genes. Results indicated that the prevalence of  jhp0945 ,  jhp0947  and  jhp0949  are associated with increased risk of severe diseases in India.    Conclusion  Our study showed that presence of  jhp0945 ,  jhp0947  and  jhp0949  were significantly associated with symptomatic expressions along with the increased virulence during in vitro study whereas  jhp0940  seems to be negatively associated with the disease. These results suggest that  jhp0945 ,  jhp0947  and  jhp0949  could be useful prognostic markers for the development of duodenal ulcer in India.

Helicobacter pylori plasticity region genes are associated with the gastroduodenal diseases manifestation in India