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Helicobacter pylori infection, anti‐cagA antibodies and peptic ulcer: a case–control study in Italy
Author(s) -
Palli D.,
Menegatti M.,
Masala G.,
Ricci C.,
Saieva C.,
Holton J.,
Gatta L.,
Miglioli M.,
Vaira D.
Publication year - 2002
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1046/j.1365-2036.2002.01253.x
Subject(s) - caga , medicine , helicobacter pylori , antibody , peptic ulcer , peptic , spirillaceae , gastroenterology , helicobacter infections , gastritis , immunology , virulence , biochemistry , chemistry , gene
Aim: To evaluate the association between infection with specific strains of Helicobacter pylori and peptic ulcer in patients referred for upper gastrointestinal endoscopy. Methods: One thousand, six hundred and twenty‐six consecutive dyspeptic patients, referred to one Endoscopy Unit in Bologna, Italy, were enrolled. For each participant, a blood sample was obtained for the measurement of distinct immunoglobulin G antibodies against H. pylori lysate and cytotoxin associated gene A (cagA). A case–control study included the whole series: patients diagnosed with duodenal ( n =275) or gastric ( n =71) ulcer were identified and independently compared with controls with non‐ulcer dyspepsia ( n =1280). Results: H. pylori seroprevalence (at least one positive marker) was associated with increasing age, male sex and a diagnosis of peptic ulcer. This association was stronger with duodenal ulcer (multivariate odds ratio (OR), 5.2; 95% confidence interval (CI), 3.5–7.9) than with gastric ulcer (OR, 2.3; 95% CI, 1.2–4.4). Further analyses showed that H. pylori lysate+/cagA− subjects had a moderately increased risk of duodenal (OR, 3.2), but not gastric (OR, 1.1), ulcer. When cagA+ subjects were separately compared with seronegative patients, there was a six‐fold increased risk for duodenal ulcer and a three‐fold increased risk for gastric ulcer. Conclusions: A strong positive association between infection with a cagA+ H. pylori strain and the presence of peptic disease was found. The seroprevalence of anti‐cagA antibodies among patients with non‐ulcer dyspepsia is so high (41%) to preclude its use as a pre‐endoscopic screening test.