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Background    Helicobacter pylori  is associated with chronic gastritis, peptic ulcers, and gastric cancer. The aim of this study was to assess the topographical distribution of  H. pylori  in the stomach as well as the  vacA  and  cagA  genotypes in patients with and without gastric cancer.    Methodology/Principal Findings  Three gastric biopsies, from predetermined regions, were evaluated in 16 patients with gastric cancer and 14 patients with dyspeptic symptoms. From cancer patients, additional biopsy specimens were obtained from tumor centers and margins; among these samples, the presence of  H. pylori vacA  and  cagA  genotypes was evaluated. Positive  H. pylori  was 38% and 26% in biopsies obtained from the gastric cancer and non-cancer groups, respectively ( p  = 0.008), and 36% in tumor sites. In cancer patients, we found a preferential distribution of  H. pylori  in the fundus and corpus, whereas, in the non-cancer group, the distribution was uniform ( p  = 0.003). A majority of the biopsies were simultaneously  cagA  gene-positive and -negative. The fundus and corpus demonstrated a higher positivity rate for the  cagA  gene in the non-cancer group ( p  = 0.036). A mixture of  cagA  gene sizes was also significantly more frequent in this group ( p  = 0.003). Ninety-two percent of all the subjects showed more than one  vacA  gene genotype; s1b and m1  vacA  genotypes were predominantly found in the gastric cancer group. The highest  vacA -genotype signal-sequence diversity was found in the corpus and 5 cm from tumor margins.    Conclusion/Significance  High  H. pylori  colonization diversity, along with the  cagA  gene, was found predominantly in the fundus and corpus of patients with gastric cancer. The genotype diversity observed across systematic whole-organ and tumor sampling was remarkable. We find that there is insufficient evidence to support the association of one isolate with a specific disease, due to the multistrain nature of  H. pylori  infection shown in this work.

High Diversity of vacA and cagA Helicobacter pylori Genotypes in Patients with and without Gastric Cancer