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Background   Helicobacter pylori  BabA is an important outer membrane protein that involves in the attachment to the gastric mucosa and enhances the virulence property of the bacterium. This study was aimed to characterize the  bab  genotypes, to evaluate its association with  cagA ,  vacA  and clinical diseases as well as degree of gastric inflammation.    Methods   H .  pylori  isolates from four countries were subjected for the characterization of  bab . The locus specific forward and  bab  specific reverse primers were used to get the specific products by PCR, which could distinguish the three locus (A, B and C). The histological activities were evaluated according to the Updated Sydney system.    Result  In patients from high risk countries (Bhutan and Myanmar) relatively higher frequencies of strains with  babA -positivity (91.8% and 90.7%, respectively),  babA  at locus A (98% and 91.2%, respectively) and with single  babA  (96.8% and 91.2%, respectively) were found. Strains with two loci occupied were the most prevalent in Bhutan (84.6%), Myanmar (74.7%), Nepal (58.3%) and Bangladesh (56.9%). The genotype  babA  at locus A /babB  at locus B /bab -negative at locus C ( babA/babB /-) was the most common genotype isolated from Bhutan (82.7%), Myanmar (58.7%), Nepal (32%) and Bangladesh (31.4%) among all genotypes assessed. This genotype was also associated with the peptic ulcer disease (P = 0.013) when compared to gastritis.  babA -positive characteristics and the genotype  babA/babB /- exhibited the enhanced histological activities.    Conclusions  The higher prevalence of virulence associated  babA -positive characteristics and enhanced histological activities in Bhutan than in Myanmar, Nepal and Bangladesh might partly explain why the peoples in Bhutan are at higher risk for developing severe gastric complications.

Helicobacter pylori bab characterization in clinical isolates from Bhutan, Myanmar, Nepal and Bangladesh