Gastroenterology

Gastroenterology

Volume 116, Issue 4, April 1999, Pages 823-830
Gastroenterology

Alimentary Tract
Geographic distribution of vacA allelic types of Helicobacter pylori,☆☆

https://doi.org/10.1016/S0016-5085(99)70065-XGet rights and content

Abstract

Background & Aims: Distinct allelic types of Helicobacter pylori vacA have been defined. The geographic distribution of vacA alleles and cagA was assessed in this study. Methods: A total of 735 cultures from patients in 24 countries were analyzed by polymerase chain reaction and reverse hybridization on a line probe assay (LiPA). Results: In 124 (16.9%) of the 735 cultures, multiple vacA genotypes were detected, permitting analysis of 611 strains. In Europe, a distribution gradient of s1 subtypes was observed. In northern and eastern Europe, 89% were subtype s1a. s1a and s1b were equally present in France and Italy, whereas in Spain and Portugal 89% of strains were subtype s1b. s1a and s1b were approximately equally prevalent in North America. In Central and South America, virtually all s1 strains were subtype s1b. Subtype s1c was observed in 77% of the s1 isolates from East Asia. m1 and m2a have equal presence, except on the Iberian peninsula and in Central and South America, where m1 (86.2%) is more prevalent than m2 (13.8%). Subtype m2b was found exclusively among East Asian s1c strains. In all parts of the world, vacA s1/cagA-positive genotypes were associated with peptic ulcer disease (P < 0.001). Conclusions: These data indicate a geographic distribution of H. pylori genotypes and aid in understanding the relationship of H. pylori with disease.

GASTROENTEROLOGY 1999;116:823-830

Section snippets

H. pylori cultures

A total of 735 H. pylori cultures were obtained from the following countries: Australia (n = 28), Brazil (n = 57), Canada (n = 13), Czech Republic (n = 13), China (n = 6), Colombia (n = 6), Costa Rica (n = 36), Egypt (n = 33), France (n = 58), Germany (n = 22), Hong Kong (n = 52), Hungary (n = 14), Italy (n = 32), Japan (n = 12), The Netherlands (n = 96), Peru (n = 6), Poland (n = 23), Portugal (n = 92), Romania (n = 23), Spain (n = 9), Sweden (n = 18), Thailand (n = 4), the United Kingdom (n =

Results

The geographic distribution of the vacA allelic types was investigated by analysis of 735 H. pylori cultures obtained from patients in 24 countries. In 124 (16.9%) of the 735 cultures, multiple vacA genotypes were detected in either the s-region (29.8%), the m-region (37.9%), or both (32.3%). The prevalence of cultures containing multiple strains varied between countries. In northern Europe, France, and Italy, only 34 (10.6%) of the 321 cultures contained multiple vacA types, whereas in

Discussion

H. pylori has a worldwide distribution, and the prevalence ranges from approximately 25% in developed countries to more than 80% in the developing world.38, 39 However, the incidence of H. pylori–associated diseases is not evenly distributed around the globe, even when correcting for H. pylori prevalence. This phenomenon may be due to heterogeneous host genetic factors, socioeconomic status, and environmental differences36, 40, 41, 42 or to the existence of distinct H. pylori genotypes.8, 9

Acknowledgements

The authors thank Drs. C. Pinho and J.M. Soares (Department of Gastroenterology, Hospital S. António, Porto, Portugal) and C.L.A.M. van Hoek (Delft Diagnostic Laboratory, Delft, the Netherlands).

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    Address requests for reprints to: Leen-Jan van Doorn, Ph.D., Delft Diagnostic Laboratory, R. de Graafweg 7, 2625 AD, Delft, The Netherlands. e-mail: [email protected]; fax: (31) 15-2604550.

    ☆☆

    Supported by Project 1/2.1/SAU/1356/95 from Portuguese Foundation for Science and Technology (PRAXIS XXI) (to C.F.); in part by R01 DK 53707 from the National Institutes of Health and the Medical Research Service of the Department of Veterans Affairs; and by Financiadora de Projectos and Consellio Nacional de Desenvolvimento Cientifico e Tecnologico-Brazil (to D.M.M.Q.).

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