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Background   Helicobacter pylori  infection increases risk for gastric cancer. Geographic variation in gastric cancer risk has been attributed to variation in carriage and type of the  H .  pylori  oncogene  cagA . Colonization density may also influence disease and  cagA  has been associated with higher shedding in stool. However, the relationship between  H .  pylori  load in the stool and in the stomach is not clear.    Methods  To investigate possible differences in  H .  pylori  load in the stomach and shedding in stool,  H .  pylori  load and  cagA  genotype were assessed using droplet digital PCR assays on gastric mucosa and stool samples from 49 urea breath test-positive individuals, including 25 gastric cancer and 24 non-cancer subjects at Henan Cancer Hospital, Henan, China.    Results  Quantitation of  H .  pylori  DNA indicated similar gastric loads among cancer and non-cancer cases, but the gastric cancer group had a median  H .  pylori  load in the stool that was six times higher than that of the non-cancer subjects. While the  cagA  gene was uniformly present among study subjects, only 70% had the East Asian  cagA  allele, which was significantly associated with gastric cancer (Fisher’s Exact Test, p = 0.03).    Conclusion   H .  pylori  persists in a subset of gastric cancer cases and thus may contribute to cancer progression. In this East Asian population with a high prevalence of the  cagA  gene, the East Asian allele could still provide a marker for gastric cancer risk.    Impact  This study contributes to our understanding of  H .  pylori  dynamics in the context of pathological changes.

Increased H. pylori stool shedding and EPIYA-D cagA alleles are associated with gastric cancer in an East Asian hospital