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Anti-CagA positivity in duodenal ulcer and functional dyspepsia patients infected with Helicobacter pylori and its effect on the outcome of eradication treatment

Year 2011, Volume: 38 Issue: 1, 7 - 11, 01.03.2011
https://doi.org/10.5798/diclemedj.0921

Abstract

Objectives: CagA positive H. pylori strains are considered to be more virulent than other strains. In this study, we aimed to investigate the rate of CagA positivity in duodenal ulcer (DU) and functional dyspepsia (FD), and its effect on H. pylori eradication response. Materials and methods: The study was performed on H. pylori positive 60 patients with DU and 50 patients with FD, who underwent upper gastrointestinal endoscopy. H. pylori infection was identified by histology. All patients received a quadriple therapy consisted of esomeprazole 20 mg b.i.d., colloidal bismuth subcitrate 600 mg b.i.d., tetracycline 500 mg q.i.d. and metronidazole 500 mg t.i.d. for 7 days. H.pylori status was rechecked using C14-urea breath test 6 weeks after the end of treatment to confirm cure. Specific IgG antibodies for CagA status were determined by enzyme linked immunosorbent assay. Results: CagA positivities in the patients with DU and FD were calculated respectivily 70% and 68% (P>0.05). H. pylori was eradicated in 85.5% of the patients infected with CagA (+) strains, in 50% of those infected with CagA (-) strains (P=0.001). The eradication rates were 95.2% and 55.6% in CagA positive and negative DU subgroups (P=0.001), and 73.5% and 43.8% in CagA positive and negative FD subgroups (P=0.04). Conclusion: CagA positivities were not different in duodenal ulcer and functional dyspepsia. CagA (+) strains was susceptible to the eradication treatment. The titres of serum anti-CagA antibodies may be used in the prediction of eradication outcome, and the modification of eradication therapy.

References

  • Clyne M, Dolan B, Reeves EP. Bacterial factors that mediate colonization of the stomach and virulence of Helicobacter pylori. FEMS Microbiol Lett 2007; 268: 135-143.
  • Jang S, Jones KR, Olsen CH et al. Epidemiological link between gastric disease and polymorphisms in vacA and cagA. J Clin Microbiol 2010; 48: 559-567.
  • Brown LM. Helicobacter pylori: epidemiology and routes of transmission. Epidemiol Rev 2000; 22: 283-297.
  • Beswick EJ, Suarez G, Reyes VE. H pylori and host inter- actions that influence pathogenesis. World J Gastroenterol 2006; 12: 5599-5605
  • Yılmaz M, Aydın A. Ungan M. et al. The relationship be- tween cagA positivity and serum gastrin and TNF- alpha levels in patients with chronic active gastritis and duodenal ulcer associated with Helicobacter pylori. Turk J Gastroen- terol 1999; 10: 385-390.
  • Saruç M, Demir MA, Küçükmetin N, et al. Predictive value of tissue cagA status in Helicobacter pylori infection. Turk J Gastroenterol 2001; 12: 27-31.
  • Ağbaba E, Nazlıgül Y, Yeniova AÖ, ve ark. Helikobakter pirli eradikasyonunun fonksiyonel dispepsi sendromları üzerine kısa dönem etkileri. Dicle Tıp Derg 2010;37:211-216.
  • Go MF, Graham DY. Presence of the cagA gene in the major- ity of Helicobacter pylori strains is independent of whether the individual has duodenal ulcer or asymptomatic gastritis. Helicobacter 1996; 1: 107-111.
  • Pan ZJ, van der Hulst RW, Feller M, et al. Equally high prev- alences of infection with cagA-positive Helicobacter pylori in Chinese patients with peptic ulcer disease and those with chronic gastritis-associated dyspepsia. J Clin Microbiol 1997; 35: 1344-1347.
  • Ali M, Khan AA, Tiwari SK, Ahmed N, Rao LV, Habibul- lah CM. Association between cag-pathogenicity island in Helicobacter pylori isolates from peptic ulcer, gastric car- cinoma, and non-ulcer dyspepsia subjects with histological changes. World J Gastroenterol 2005; 11: 6815-6822.
  • Peters TM, Owen RJ, Slater E, Varea R, Teare EL, Sav- erymuttu S. Genetic diversity in the Helicobacter pylori cag pathogenicity island and effect on expression of anti- CagA serum antibody in UK patients with dyspepsia. J Clin Pathol 2001;54:219-223.
  • Wang Y, Luo YH, Yan J. Detection of cagA gene, CagA protein in Helicobacter pylori isolates and its antibody in serum of patients with gastric diseases by a recombinant protein CagA 1. Zhejiang Da Xue Xue Bao Yi Xue Ban 2005;34:223-229.
  • Kumar S, Dhar A, Srinivasan S, Jain S, Rattan A, Sharma MP. Antibodies to CagA protein are not predictive of seri- ous gastroduodenal disease in Indian patients. Indian J Gas- troenterol 1998; 17: 126-128.
  • Lu H, Hsu PI, Graham DY, Yamaoka Y. Duodenal ulcer promoting gene of Helicobacter pylori. Gastroenterology 2005; 128: 833-848.
  • Imagawa S, Ito M, Yoshihara M, Eguchi H, Tanaka S, Chayama K. Helicobacter pylori dupA and gastric acid se- cretion are negatively associated with gastric cancer devel- opment. J Med Microbiol. 2010;59:1484-1489.
  • Nguyen LT, Uchida T, Tsukamoto Y et al. Helicobacter pylori dupA gene is not associated with clinical outcomes in the Japanese population. Clin Microbiol Infect 2010;16:1264- 1269.
  • Queiroz DM, Rocha GA, Rocha AM et al. dupA polymor- phisms and risk of Helicobacter pylori-associated diseases. Int J Med Microbiol. 2010. [Baskıda]
  • Saruç M, Göksel G, Özkaya S, Güçlü F, Özbakkaloğlu B, Yüceyar H. Helicobacter pylori eradikasyonunda suş fark- lılığı başarıyı etkileyen bir faktör müdür? Turk J Gastroen- terol 2000; 11: 146-149.
  • Rudi J, Reuther S, Sieg A, Hoerner M, Stremmel W. Rel- evance of underlying disease and bacterial vaca and caga status on the efficacy of Helicobacter pylori eradication. Digestion 2002;65:11-15.
  • Zhao JJ, Wang JB, Yang L, Li Y. Influence of Helicobacter pylori genotype on triple eradication therapy. J Gastroen- terol Hepatol 2007; 22: 2251-2255.
  • Toro C, García-Samaniego J, Alarcón T, Baquero M. [As- sociation among anti-CagA antibody detection, antibiotic susceptibility, and peptic ulcer in patients with Helicobacter pylori infection] Enferm Infecc Microbiol Clin 2003; 21: 137-141.
  • Taneike I, Nami A, O’Connor A et al. Analysis of drug resis- tance and virulence-factor genotype of Irish Helicobacter pylori strains: is there any relationship between resistance to metronidazole and cagA status? Aliment Pharmacol Ther 2009; 30: 784-790.
  • Sugimoto M, Yamaoka Y. Virulence factor genotypes of Helicobacter pylori affect cure rates of eradication therapy. Arch Immunol Ther Exp (Warsz) 2009; 57: 45-56.
  • Broutet N, Marais A, Lamouliatte H, et al. CagA status and eradication treatment outcome of anti-Helicobacter pylori triple therapies in patients with nonulcer dyspepsia. J Clin Microbiol 2001; 39: 1319-1322.
  • Gisbert JP, Marcos S, Gisbert JL, Pajares JM. Helicobacter pylori eradication therapy is more effective in peptic ulcer than in non-ulcer dyspepsia. Eur J Gastroenterol Hepatol. 2001; 13: 1303-1307.
  • Chung SJ, Lee DH, Kim N, et al. Eradication rates of He- licobacter pylori infection with second-line treatment: non- ulcer dyspepsia compared to peptic ulcer disease. Hepato- gastroenterology 2007; 54: 1293-1296.
  • Gisbert JP, Hermida C, Pajares JM. Are twelve days of omeprazole, amoxicillin and clarithromycin better than six days for treating H. pylori infection in peptic ulcer and in non-ulcer dyspepsia? Hepatogastroenterology 2001; 48: 1383-1388.
  • Vakil N, Lanza F, Schwartz H, Barth J. Seven-day therapy for Helicobacter pylori in the United States. Aliment Phar- macol Ther 2004; 20: 99-107.
  • Hong EJ, Park DI, Oh SJ et al. Comparison of Helicobacter pylori eradication rate in patients with non-ulcer dyspepsia and peptic ulcer diseases according to proton pump inhibi- tors. Korean J Gastroenterol. 2008; 52: 80-85.
  • de Boer WA. Eradication therapy should be different for dyspeptic patients than for ulcer patients. Can J Gastroen- terol 2003;17:41-45.
  • Garza-González E, Pérez-Pérez GI, Tijerina-Menchaca R, Maldonado-Garza HJ, Bosques-Padilla FJ. Helicobacter pylori genotypes and their association with host’s immune response. Rev Gastroenterol Mex. 2002; 67: 155-160.

Helicobakter pilori ile enfekte duodenal ülser ve fonksiyonel dispepsi hastalarında anti-CagA pozitifliği ve eradikasyon tedavi başarısına etkisi

Year 2011, Volume: 38 Issue: 1, 7 - 11, 01.03.2011
https://doi.org/10.5798/diclemedj.0921

Abstract

Amaç: CagA pozitif H. pilori suşlarının daha virülan olduğu kabul edilmektedir. Bu çalışmada duodenal ülser (DÜ) ve fonksiyonel dispepsi (FD) hastalarında CagA pozitiflik prevalansını ve CagA pozitifliğinin eradikasyon tedavisine etkisini araştırmayı amaçladık. Gereç ve yöntem: Çalışma, üst gastrointestinal endoskopi yapılan H.pilori pozitif 60 DÜ ile 50 FD hastasında gerçekleştirildi. H. pilori durumu histoloji yöntemiyle belirlendi. Hastaların tamamına esomeprozol 20 mg 2x1, kolloidal bizmut subsitrat 300 mg 2x2, metronidazol 500 mg 3x1, tetrasiklin 500 mg 4x1 oluşan dörtlü tedavi 1 hafta süreyle verildi. Eradikasyon kontrolü, tedavi bitiminden 6 hafta sonra C-14 üre nefes testiyle yapıldı. Serum anti-CagA Ig G antikor titreleri, ELISA yöntemiyle çalışıldı. Bulgular: CagA pozitifliği duodenal ülser ve fonksiyonel dispepsi hastalarında sırasıyla % 70 ve % 68 bulundu (P>0.05). CagA pozitif ve negatif hastalarda H. pilori eradikasyon oranları % 85.5 ve % 50 idi (P=0.001). DÜ hastalarının CagA pozitif ve negatif alt gruplarında eradikasyon oranları % 95.2 ve % 55.6 oldu (P=0.001). FD hastalarının CagA durumları pozitif olanlarında % 73.5, negatif olanlarında % 43.8 eradikasyon oranları sağlandı (P=0.04). Sonuç: CagA prevalansı, duodenal ülser hastalarında fonksiyonel dispepsi hastalarından farklı bulunmadı. CagA pozitif suşlar, eradikasyon tedavisine daha duyarlıdır. Serolojik anti-CagA pozitifliği, tedavi cevabını öngörmekte ve tedaviyi modifiye etmekte kullanılabilir.

References

  • Clyne M, Dolan B, Reeves EP. Bacterial factors that mediate colonization of the stomach and virulence of Helicobacter pylori. FEMS Microbiol Lett 2007; 268: 135-143.
  • Jang S, Jones KR, Olsen CH et al. Epidemiological link between gastric disease and polymorphisms in vacA and cagA. J Clin Microbiol 2010; 48: 559-567.
  • Brown LM. Helicobacter pylori: epidemiology and routes of transmission. Epidemiol Rev 2000; 22: 283-297.
  • Beswick EJ, Suarez G, Reyes VE. H pylori and host inter- actions that influence pathogenesis. World J Gastroenterol 2006; 12: 5599-5605
  • Yılmaz M, Aydın A. Ungan M. et al. The relationship be- tween cagA positivity and serum gastrin and TNF- alpha levels in patients with chronic active gastritis and duodenal ulcer associated with Helicobacter pylori. Turk J Gastroen- terol 1999; 10: 385-390.
  • Saruç M, Demir MA, Küçükmetin N, et al. Predictive value of tissue cagA status in Helicobacter pylori infection. Turk J Gastroenterol 2001; 12: 27-31.
  • Ağbaba E, Nazlıgül Y, Yeniova AÖ, ve ark. Helikobakter pirli eradikasyonunun fonksiyonel dispepsi sendromları üzerine kısa dönem etkileri. Dicle Tıp Derg 2010;37:211-216.
  • Go MF, Graham DY. Presence of the cagA gene in the major- ity of Helicobacter pylori strains is independent of whether the individual has duodenal ulcer or asymptomatic gastritis. Helicobacter 1996; 1: 107-111.
  • Pan ZJ, van der Hulst RW, Feller M, et al. Equally high prev- alences of infection with cagA-positive Helicobacter pylori in Chinese patients with peptic ulcer disease and those with chronic gastritis-associated dyspepsia. J Clin Microbiol 1997; 35: 1344-1347.
  • Ali M, Khan AA, Tiwari SK, Ahmed N, Rao LV, Habibul- lah CM. Association between cag-pathogenicity island in Helicobacter pylori isolates from peptic ulcer, gastric car- cinoma, and non-ulcer dyspepsia subjects with histological changes. World J Gastroenterol 2005; 11: 6815-6822.
  • Peters TM, Owen RJ, Slater E, Varea R, Teare EL, Sav- erymuttu S. Genetic diversity in the Helicobacter pylori cag pathogenicity island and effect on expression of anti- CagA serum antibody in UK patients with dyspepsia. J Clin Pathol 2001;54:219-223.
  • Wang Y, Luo YH, Yan J. Detection of cagA gene, CagA protein in Helicobacter pylori isolates and its antibody in serum of patients with gastric diseases by a recombinant protein CagA 1. Zhejiang Da Xue Xue Bao Yi Xue Ban 2005;34:223-229.
  • Kumar S, Dhar A, Srinivasan S, Jain S, Rattan A, Sharma MP. Antibodies to CagA protein are not predictive of seri- ous gastroduodenal disease in Indian patients. Indian J Gas- troenterol 1998; 17: 126-128.
  • Lu H, Hsu PI, Graham DY, Yamaoka Y. Duodenal ulcer promoting gene of Helicobacter pylori. Gastroenterology 2005; 128: 833-848.
  • Imagawa S, Ito M, Yoshihara M, Eguchi H, Tanaka S, Chayama K. Helicobacter pylori dupA and gastric acid se- cretion are negatively associated with gastric cancer devel- opment. J Med Microbiol. 2010;59:1484-1489.
  • Nguyen LT, Uchida T, Tsukamoto Y et al. Helicobacter pylori dupA gene is not associated with clinical outcomes in the Japanese population. Clin Microbiol Infect 2010;16:1264- 1269.
  • Queiroz DM, Rocha GA, Rocha AM et al. dupA polymor- phisms and risk of Helicobacter pylori-associated diseases. Int J Med Microbiol. 2010. [Baskıda]
  • Saruç M, Göksel G, Özkaya S, Güçlü F, Özbakkaloğlu B, Yüceyar H. Helicobacter pylori eradikasyonunda suş fark- lılığı başarıyı etkileyen bir faktör müdür? Turk J Gastroen- terol 2000; 11: 146-149.
  • Rudi J, Reuther S, Sieg A, Hoerner M, Stremmel W. Rel- evance of underlying disease and bacterial vaca and caga status on the efficacy of Helicobacter pylori eradication. Digestion 2002;65:11-15.
  • Zhao JJ, Wang JB, Yang L, Li Y. Influence of Helicobacter pylori genotype on triple eradication therapy. J Gastroen- terol Hepatol 2007; 22: 2251-2255.
  • Toro C, García-Samaniego J, Alarcón T, Baquero M. [As- sociation among anti-CagA antibody detection, antibiotic susceptibility, and peptic ulcer in patients with Helicobacter pylori infection] Enferm Infecc Microbiol Clin 2003; 21: 137-141.
  • Taneike I, Nami A, O’Connor A et al. Analysis of drug resis- tance and virulence-factor genotype of Irish Helicobacter pylori strains: is there any relationship between resistance to metronidazole and cagA status? Aliment Pharmacol Ther 2009; 30: 784-790.
  • Sugimoto M, Yamaoka Y. Virulence factor genotypes of Helicobacter pylori affect cure rates of eradication therapy. Arch Immunol Ther Exp (Warsz) 2009; 57: 45-56.
  • Broutet N, Marais A, Lamouliatte H, et al. CagA status and eradication treatment outcome of anti-Helicobacter pylori triple therapies in patients with nonulcer dyspepsia. J Clin Microbiol 2001; 39: 1319-1322.
  • Gisbert JP, Marcos S, Gisbert JL, Pajares JM. Helicobacter pylori eradication therapy is more effective in peptic ulcer than in non-ulcer dyspepsia. Eur J Gastroenterol Hepatol. 2001; 13: 1303-1307.
  • Chung SJ, Lee DH, Kim N, et al. Eradication rates of He- licobacter pylori infection with second-line treatment: non- ulcer dyspepsia compared to peptic ulcer disease. Hepato- gastroenterology 2007; 54: 1293-1296.
  • Gisbert JP, Hermida C, Pajares JM. Are twelve days of omeprazole, amoxicillin and clarithromycin better than six days for treating H. pylori infection in peptic ulcer and in non-ulcer dyspepsia? Hepatogastroenterology 2001; 48: 1383-1388.
  • Vakil N, Lanza F, Schwartz H, Barth J. Seven-day therapy for Helicobacter pylori in the United States. Aliment Phar- macol Ther 2004; 20: 99-107.
  • Hong EJ, Park DI, Oh SJ et al. Comparison of Helicobacter pylori eradication rate in patients with non-ulcer dyspepsia and peptic ulcer diseases according to proton pump inhibi- tors. Korean J Gastroenterol. 2008; 52: 80-85.
  • de Boer WA. Eradication therapy should be different for dyspeptic patients than for ulcer patients. Can J Gastroen- terol 2003;17:41-45.
  • Garza-González E, Pérez-Pérez GI, Tijerina-Menchaca R, Maldonado-Garza HJ, Bosques-Padilla FJ. Helicobacter pylori genotypes and their association with host’s immune response. Rev Gastroenterol Mex. 2002; 67: 155-160.
There are 31 citations in total.

Details

Primary Language Turkish
Journal Section Research Articles
Authors

Elif Doğan This is me

Ayşe Kefeli This is me

Yaşar Nazlıgül This is me

Abdullah Özgür Yeniova This is me

Metin Küçükazman This is me

Zeynep Çizmeci This is me

Servet Güreşci This is me

Cihan Fidan This is me

Publication Date March 1, 2011
Submission Date March 2, 2015
Published in Issue Year 2011 Volume: 38 Issue: 1

Cite

APA Doğan, E., Kefeli, A., Nazlıgül, Y., Yeniova, A. Ö., et al. (2011). Helicobakter pilori ile enfekte duodenal ülser ve fonksiyonel dispepsi hastalarında anti-CagA pozitifliği ve eradikasyon tedavi başarısına etkisi. Dicle Tıp Dergisi, 38(1), 7-11. https://doi.org/10.5798/diclemedj.0921
AMA Doğan E, Kefeli A, Nazlıgül Y, Yeniova AÖ, Küçükazman M, Çizmeci Z, Güreşci S, Fidan C. Helicobakter pilori ile enfekte duodenal ülser ve fonksiyonel dispepsi hastalarında anti-CagA pozitifliği ve eradikasyon tedavi başarısına etkisi. diclemedj. March 2011;38(1):7-11. doi:10.5798/diclemedj.0921
Chicago Doğan, Elif, Ayşe Kefeli, Yaşar Nazlıgül, Abdullah Özgür Yeniova, Metin Küçükazman, Zeynep Çizmeci, Servet Güreşci, and Cihan Fidan. “Helicobakter Pilori Ile Enfekte Duodenal ülser Ve Fonksiyonel Dispepsi hastalarında Anti-CagA pozitifliği Ve Eradikasyon Tedavi başarısına Etkisi”. Dicle Tıp Dergisi 38, no. 1 (March 2011): 7-11. https://doi.org/10.5798/diclemedj.0921.
EndNote Doğan E, Kefeli A, Nazlıgül Y, Yeniova AÖ, Küçükazman M, Çizmeci Z, Güreşci S, Fidan C (March 1, 2011) Helicobakter pilori ile enfekte duodenal ülser ve fonksiyonel dispepsi hastalarında anti-CagA pozitifliği ve eradikasyon tedavi başarısına etkisi. Dicle Tıp Dergisi 38 1 7–11.
IEEE E. Doğan, “Helicobakter pilori ile enfekte duodenal ülser ve fonksiyonel dispepsi hastalarında anti-CagA pozitifliği ve eradikasyon tedavi başarısına etkisi”, diclemedj, vol. 38, no. 1, pp. 7–11, 2011, doi: 10.5798/diclemedj.0921.
ISNAD Doğan, Elif et al. “Helicobakter Pilori Ile Enfekte Duodenal ülser Ve Fonksiyonel Dispepsi hastalarında Anti-CagA pozitifliği Ve Eradikasyon Tedavi başarısına Etkisi”. Dicle Tıp Dergisi 38/1 (March 2011), 7-11. https://doi.org/10.5798/diclemedj.0921.
JAMA Doğan E, Kefeli A, Nazlıgül Y, Yeniova AÖ, Küçükazman M, Çizmeci Z, Güreşci S, Fidan C. Helicobakter pilori ile enfekte duodenal ülser ve fonksiyonel dispepsi hastalarında anti-CagA pozitifliği ve eradikasyon tedavi başarısına etkisi. diclemedj. 2011;38:7–11.
MLA Doğan, Elif et al. “Helicobakter Pilori Ile Enfekte Duodenal ülser Ve Fonksiyonel Dispepsi hastalarında Anti-CagA pozitifliği Ve Eradikasyon Tedavi başarısına Etkisi”. Dicle Tıp Dergisi, vol. 38, no. 1, 2011, pp. 7-11, doi:10.5798/diclemedj.0921.
Vancouver Doğan E, Kefeli A, Nazlıgül Y, Yeniova AÖ, Küçükazman M, Çizmeci Z, Güreşci S, Fidan C. Helicobakter pilori ile enfekte duodenal ülser ve fonksiyonel dispepsi hastalarında anti-CagA pozitifliği ve eradikasyon tedavi başarısına etkisi. diclemedj. 2011;38(1):7-11.