The prevalence and clinical relevance of Helicobacter pylori and its cagA and iceA genotypes in peptic ulcer and non-ulcer dyspepsia patients in Hospital Tengku Ampuan Afzan (HTAA) Kuantan, Pahang, Malaysia

Abstract

There is a geographic variation in the prevalence of Helicobacter pylori virulence genes. The cagA (cytotoxin associated genes A) and iceA (induced by contact with the epithelium gene) genotypes of the organism are associated with peptic ulcer disease (PUD). This study was undertaken with the main aim of investigating the relationship between virulence factors (cagA and iceA) of H. pylori and clinical outcome and their distribution among patients of different ethnic groups in Hospital Tengku Ampuan Afzan (HTAA) Kuantan, Pahang, Malaysia. All patients with dyspepsia who have positive CLO (campylobacter like organism) test were recruited and endoscopic biopsies obtained. DNA was extracted and polymerase chain reaction was carried out to determine the presence or absence of cagA and iceA genes. There were a total of 30 patients in our study (15 men and 15 women). The mean age was 52 ±16.6 years. The ethnic distribution was 14 Chinese 8 Malay, 5 Indian and 3 others. The cagA gene was detected in 16 (53.3%) biopsy specimens, 9 (56.3%) had PUD while 7 (43.7%) had non-ulcer dyspepsia (NUD). Helicobacter pylori cagA positive strains were common in (Chinese 8 and Malay 4). The iceA1 gene was detected in 12/30 (40%) patients, 8 had NUD while 4 had PUD. Helicobacter pylori iceA1 genotypes were found in (Chinese 8, Indians 2 and others 2). The iceA2 gene was detected in 3/30 (10%) patients, all in females but in none of the Malay patients. These results suggest that probably there is a distinctive difference in the H. pylori genotypes among the three ethnic groups in Kuantan, Malaysia. A significant difference was noted between iceA1 and races (P=0.047) and there was no association between cagA, or iceA genotypes and clinical outcome in the patients.