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H. pylori Infection and Genotyping in Patients Undergoing Upper Endoscopy at Inner City Hospitals

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Abstract

Kings County Hospital (KCH), and St. John's Episcopal Hospital (SJH) are inner-city hospitals in New York City serving predominantly minority populations. Staten Island University Hospital (SIUH) serves a predominantly middle-class Caucasian population. We examined H. pylori (HP) infection in patients undergoing upper endoscopy at these hospitals. Two gastric biopsies were obtained from each patient. One biopsy was examined by histology or the rapid urease test for the presence of HP. The other was subjected to analysis by PCR to detect HP DNA and to identify putative HP virulence factors. Of 200 subjects, 54% were African-American, 10% were Hispanic, and 36% were Caucasian. HP infection rates in African-American, Hispanic, and Caucasian patients were 43%, 20%, and 11%, respectively. Many of the African-American patients are recent immigrants from the Caribbean Islands. In these patients, an inverse relationship was observed between HP infection and the number of years living in the United States. Higher levels of HP infection were observed in patients with duodenitis and peptic ulcer disease. With respect to HP virulence factors, the vacA s1b and m1 alleles, as well as the iceA2 allele were the predominant alleles expressed in HP-positive samples obtained from African-Americans. The cagA gene was detected in 81% of HP-positive samples. However, CagA positivity was not related to any specific gastrointestinal disorder. Our findings indicate that among several ethnic groups served by three hospitals, African-American patients have the highest rate of HP infection. Moreover, in African-American patients undergoing endoscopy: (1) HP infection was inversely related to the number of years the patients have been living in the USA; (2) HP infection rates were higher in patients diagnosed with duodenitis and peptic ulcer disease versus other disorders; (3) expression of the CagA gene was not associated with any specific gastroduodenal disorder; and (4) there was little allelic heterogeneity with respect to VacA and IceA subtypes. These findings suggest that inner-city African-Americans are more likely to be infected with HP and suffer from more serious gastroduodenal disorders than other ethnic groups.

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REFERENCES

  1. Blaser MJ: Helicobacter pylori: Its role in disease. Clin Infect Dis 15:386–393, 1992

    Google Scholar 

  2. Dunn BE, Cohen H, Blaser MJ: Helicobacter pylori. Clin Microbiol Rev 10:720–741, 1997

    Google Scholar 

  3. Blaser MJ: Ecology of Helicobacter pylori in the human stomach. Clin Infect Dis 100:759–762, 1997

    Google Scholar 

  4. Mobley HL: Defining Helicobacter pylori as a pathogen: Strain heterogeneity and virulence. Am J Med 100:2s–11s, 1997

    Google Scholar 

  5. Tummuru MKR, Cover TL, Blaser MJ: Cloning and expression of a high molecular mass major antigen of Helicobacter pylori: Evidence of linkage to cytotoxin production. Infect Immun 61:1799–1809, 1993

    Google Scholar 

  6. Shimoyama T, Crabtree JE: Mucosal chemokines in Helicobacter pylori infection. J Physiol Pharmacol 48:315–323, 1997

    Google Scholar 

  7. Atherton JC, Cao P, Peek RM, Yummuru MKR, Blaser MJ, Cover TL: Mosaicism in vacuolating cytotoxin alleles of Helicobacter pylori: Association of specific VacA types with cytotoxin production and peptic ulceration. J Biol Chem 270:17771–17777, 1995

    Google Scholar 

  8. Atherton JC, Peek RM, Tham KT, Cover TL, Blaser MJ: Clinical and pathological importance of heterogeneity in VacA, the vacuolating cytotoxin gene of Helicobacter pylori. Gastroenterology 112:92–99, 1997

    Google Scholar 

  9. Van Doorn LJ, Figueiredo C, Sanna R, Pena S, Midolo P, Ng EKW, Atherton JC, Blaser MJ, Quint WG: Expanding allelic diversity of Helicobacter pylori VacA. J Clin Microbiol 36:2597–2603, 1998

    Google Scholar 

  10. Peek RM, Thompson SA, Donahue JP, Tham TK, Atherton JC, Blaser MJ, Miller GG: Adherence to gastric epithelial cells induces expression of a Helicobacter pylori gene, iceA, that is associated with clinical outcome. Proc Assoc Am Physicians 110:531–544, 1998.

    Google Scholar 

  11. Yamaoka Y, Kodama T, Gutierrez O, Kim JG, Kashima K, Graham DY: Relationship between Helicobacter pylori IcaA, CagA and VacA status and clinical outcome: Studies in four different countries. J Clin Microbiol 37:2274–2279, 1999

    Google Scholar 

  12. Letley DP, Lastovica A, Louw JA, Hawkey CJ, Atherton JC: Allelic diversity of the Helicobacter pylori vacuolating cytotoxin gene in South Africa: Rarity of the VacA s1a genotype and natural occurrence of an s2/m1 allele. J Clin Microbiol 37:1203–1205, 1999

    Google Scholar 

  13. Ito Y, Azuma T, Ito S, Miyaji H, Hirai M, Yamazaki Y, Sato F, Kato T, Kohli Y, Kuriyama M: Analysis and typing of the vacA gene from cagA-positive strains of Helicobacter pylori isolated in Japan. J Clin Microbiol 35:1710–1714, 1997

    Google Scholar 

  14. Perez-Perez GI, Bhat N, Gaensbauer J, Fraser A, Taylor DN, Kuipers EJ, Zhang L, You WC, Blaser MC: Country specific constancy by age in cagA_ proportion of Helicobacter pylori infections. Int J Cancer 72:453–456, 1997

    Google Scholar 

  15. Replogle ML, Glaser SL, Hiatt RA, Parsonnet J: Biologic sex as a risk factor for Helicobacter pylori infection in healthy young adults. Am J Epidemiol 142:856–863, 1995

    Google Scholar 

  16. Cryer B, Feldman M: Racial differences in gastric function among African American and Caucasian americans: Secretion, serum gastrin and histology. Proc Assoc Am Physicians 108:481–489, 1996

    Google Scholar 

  17. Verdu EF, Fraser R, Tiberio D, Herranz M, Sipponen P, Blum AL, Michetti P: Prevalence of Helicobacter pylori infection and chronic dyspeptic symptoms among immigrants from developing countries and people born in industrialized countries. Digestion 57:180–185, 1996

    Google Scholar 

  18. Rudi J, Kolb C, Maiwald M, Kuck D, Sieg A, Galle PR, Stremmel W: Diversity of Helicobacter pylori vacA and cagA genes and relationship to VacA and CagA protein expression, cytotoxin production and associated diseases. J Clin Microbiol 36:944–948, 1998

    Google Scholar 

  19. Wang HJ, Kuo CH, Yeh AAM, Chang PCL, Wang WC: Vacuolating cytotoxin production in clinical isolates of Helicobacter pylori with different vacA genotypes. J Infect Dis 178:207–212, 1998

    Google Scholar 

  20. Yamoaka Y, Malaty HM, Osato MS, Graham DY: Conservation of Helicobacter pylori genotypes in different ethnic groups in Houston, Tex. J Infect Dis 181:2083–2086, 2000

    Google Scholar 

  21. Kidd M, Lastovica AJ, Atherton JC, Louw JA: Heterogeneity in the Helicobacter pylori vacA and cagA genes: Association with gastroduodenal disease in South Africa? Gut 45:499–502, 1999

    Google Scholar 

  22. Parsonnet J, Replogle M, Yuang S, Hiatt R: Seroprevalence of CagA-positive strains among Helicobacter pylori-infected healthy young adults. J Infect Dis 175:1240–1242, 1997

    Google Scholar 

  23. Peek JM, Moss SF, Tham KT, Perez-Perez GI, Wang S, Miller GG, Atherton JC, Holt PR, Blaser MJ: Helicobacter pylori CagA+ strains and dissociation of gastric epithelial cell proliferation from apoptosis. J Natl Cancer Inst 89:863–868, 1997

    Google Scholar 

  24. Hamlet A, Thoreson AC, Nilsson O, Svennerholm AM, Olbe L: Duodenal Helicobacter pylori infection differs in cagA genotype between asymptomatic subjects and patients with duodenal ulcers. Gastroenterology 116:259–268, 1999

    Google Scholar 

  25. Van Doorn LJ, Figueiredo C, Sanna R, Blaser MJ, Quint WGV: Distinct variants of Helicobacter pylori cagA are associated with VacA subtypes. J Clin Microbiol 37:2306–2311, 1999

    Google Scholar 

  26. Vaezi MF, Falk GW, Peek RM, Vicari JJ, Goldblum JR, Perez-Perez GI, Rice TW, Blaser MJ, Richter JE: CagApositive strains of Helicobacter pylori may protect against Barrett's esophagus. Am J Gastroenterol 95:2206–2211, 2000

    Google Scholar 

  27. Loffeld RJ, Werdmuller BF, Kuster JG, Perez-Perez GI, Blaser MJ, Kuiper EJ: Colonization with cagA-positive Helicobacter pylori strains inversely associated with reflux esophagitis and Barrett's esophagus. Digestion 62:95–99, 2000

    Google Scholar 

  28. Rokkas T, Ladas SD, Triantafyllou K, Liatsos C, Petridou E, Papatheodoro G, Karameris A, Raptis SA: The association between CagA status and the development of esophagitis after eradication of Helicobacter pylori. Am J Med 110:703–707, 2001

    Google Scholar 

  29. El-Serag HB, Sonnenberg A: Ethnic variations in the occurrence of gastroesophageal cancers. J Clin Gastroenterol 28:135–139, 1999

    Google Scholar 

  30. Atherton JC, Cover TL, Twells RJ, Morales MR, Hawkey CJ, Blaser MJ: Simple and accuratePCR-based system for typing vacuolating cytotoxin alleles of Helicobacter pylori. J Clin Microbiol 37:2979–2982, 1999

    Google Scholar 

  31. Lage AP, Godfroid E, Fauconnier A, Burette A, Butzler JP, Bollen A, Glupczynski Y: Diagnosis of Helicobacter pylori infection by PCR: Comparison with other invasive techniques and detection of CagA gene in gastric biopsy specimens. J Clin Microbiol 33:2752–2756, 1995

    Google Scholar 

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Authors and Affiliations

  1. Division of Digestive Diseases, SUNY-Downstate Medical College, 450 Clarkson Avenue, Brooklyn, New York, 11203, USA

    E.W. Straus, H. Patel, J. Chang, S. Iyer, S. Samuel & R.D. Raffaniello

  2. Division of Gastroeneterology, 327 Beech 19th Street, St. John's Episcopal Hospital, Far Rockaway, New York, 11691, USA

    R.M. Gupta

  3. Division of Gastroeneterology, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, New York, 10305, USA

    V. Sottile, J. Scirica & G. Tarabay

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  1. E.W. Straus
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  2. H. Patel
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  3. J. Chang
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  9. S. Samuel
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Straus, E., Patel, H., Chang, J. et al. H. pylori Infection and Genotyping in Patients Undergoing Upper Endoscopy at Inner City Hospitals. Dig Dis Sci 47, 1575–1581 (2002). https://doi.org/10.1023/A:1015827404901

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