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

Öz

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.

Anahtar Kelimeler

• CagA, duodenal ulcer, functional dyspepsia, Helicobacter pylori eradication.

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

Öz

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.

Anahtar Kelimeler

• CagA, duodenal ülser, fonksiyonel dispepsi, Helikobakter pilori eradikasyonu.

Kaynakça

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