H. pylori Infection and Ulcer Risk: Genetic Strain Matters

Summary and Comment |
May 25, 2012

H. pylori Infection and Ulcer Risk: Genetic Strain Matters

  1. David J. Bjorkman, MD, MSPH (HSA), SM (Epid.)

In a 5-year longitudinal study, only H. pylori infection positive for cytotoxin-associated gene A increased the risk for gastric and duodenal ulcers.

  1. David J. Bjorkman, MD, MSPH (HSA), SM (Epid.)

Most data supporting the relationship between Helicobacter pylori infection and peptic ulcer disease (PUD) come from cross-sectional or retrospective studies. Now, investigators have prospectively analyzed this association in a cohort of 9953 patients aged 50 to 74 recruited from general practices in southwest Germany.

Lifetime history of PUD was self-reported and confirmed with medical records. Presence of H. pylori infection, including status as positive or negative for cytotoxin-associated gene A (cagA), was ascertained by serology. Reports of incident ulcers were confirmed by physicians and identified as duodenal or gastric ulcers.

In a cross-sectional analysis involving 8699 participants, a lifetime history of PUD was associated with cagA-positive H. pylori infection (odds ratio, 1.75; 95% confidence interval, 1.50–2.04) but not with cagA-negative H. pylori infection. In a longitudinal analysis, PUD developed in 69 of 7284 participants (gastric ulcers in 47, duodenal ulcers in 21, and both in 1) during a mean follow-up of 4.8 years (incidence rate, 1.96 per 1000 person-years). In multivariate analysis, a family history of PUD (adjusted hazard ratio, 3.01; 95% CI, 1.70–5.32) and cagA-positive H. pylori infection (adjusted HR, 2.87; 95% CI, 1.51–5.46) were associated with an increased risk for gastric ulcer. Infection with cagA-positive H. pylori was strongly associated with duodenal ulcer (adjusted HR, 18.40; 95% CI, 4.24–79.9).

Comment

The authors suggest that the proportion of peptic ulcer disease attributable to H. pylori infection might be larger than previously recognized. The current findings support the association between cagA-positive H. pylori infection and PUD using both cross-sectional and longitudinal observational analyses. The association of cagA-positive H. pylori infection with duodenal ulcers was particularly strong compared with the association for gastric ulcers.

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