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Gastric cancer risk is varied among different regions of Thailand. We examined the characteristics of  Helicobacter pylori  infection in two regions of Thailand. The  H .  pylori  status of 273 dyspeptic patients (136 from the South and 137 from the North; a low and high incidence of gastric cancer region, respectively) was evaluated, and virulence genotypes ( cagA ,  vacA ,  hrgA  and  jhp0562 -positive/ β-(1 , 3)galT ) were determined. The overall  H .  pylori  infection rate was 34.1% (93/273). The prevalence was higher in the North than in the South (50.4% vs. 17.6%, P <0.001) and was significantly higher among individuals with the following characteristics: low income, birthplace in the Northeast or North regions, agricultural employment, or consumption of alcohol or unboiling water. Among these socio-demographic determinants, region was an independent risk factor for  H .  pylori  infection (odds ratio = 6.37). Patients including both  H .  pylori  infected and uninfected cases who lived in the North had significantly more severe histological scores than those in the South. In contrast, among  H .  pylori -positive cases, patients in the South had significantly more severe histological scores than those in the North. Of the 74 strains cultured, 56.8% carried Western-type  cagA , with a higher proportion in the South than in the North (76.2% vs. 49.1%, P = 0.05). In disagreement with the current consensus, patients infected with the Western-type  cagA  strains had more severe inflammation scores in the antrum than those infected with the East Asian-type  cagA  strains (P = 0.027). Moreover, Western-type  cagA  strains induced more severe histological scores in patients from the South than those of either genotype from the North. Other virulence genes had no influence on histological scores. The incidence of gastric cancer in Thailand was different among regions and corresponded to differences in the prevalence of  H .  pylori  infection. More careful follow-up for patients in the South will be required, even if they are infected with  H .  pylori  carrying Western-type  cagA .

Prevalence, risk factors, and virulence genes of Helicobacter pylori among dyspeptic patients in two different gastric cancer risk regions of Thailand