Correlation of Gastric Mucosal Inflammation and Proliferating Activity according to Helicobacter pylori phenotype

Seo, Young Ho; Ahn, Hyun Taek; Lee, Wan Sik; Oh, Won Tae; Kim, Hyun Su; Choi, Sung Kyu; Rew, Jong Sun; Kim, Sei Jong; Kim, Joon Soon; Park, Chang Su

Abstract

Background/Aims
Helicobacter pylori(H. pylori) infection is associated with gastritis, duodenal ulcer, gastric ulcer and gastric cancer. However, only small proportion of infected persons develop disease. H. pylori phenotype is regarded as one of the major factors in determinig the degree of inflammation and diversity of disease expression. This study was performed to assess the role of the pheontypic expression of H. pylori in gastric mucosal inflammation and proliferating activity.
Methods
Fifty five patients(13 chronic atrophic gastritis;CAG, 19gastric ulcer;GU,10 duodenal ulcer;DU, 13 gastric cancer;GC) undergoing endoscopy were included in the study. H. pylori infection assessed by CLOTM test(Delta West Pty Ltd, Australia) and detection H. pylori in H&e stain. Serum of the patients were tested by Helicoblot 2.0 kit(Genelabs Diagnostics, Singapore) designed for the detection of various serum lgG antibodies against H. pylori antigens inculding cagA & vacA. The H. pylori positive patients were divided into 3 groups, group 1(cagA+/vacA+), group 2(cagA+/vacA-), group 3(cagA-/vacA-), and non-infected patients were group 4(control; CLO negative and H&E stain negative). Degree of inflammation on biopsied specimen was graded by the degree of lymphocyte infilteration, neutrophil infilteration, atrophy and intestinal metaplasia. Proliferating activity of biopsied specimen was graded by immunohistochemical stain of PCNA. Histologic findings were compared within H. pylori groups.
Results
Mean age of the studied subjects was 53.6+/-12.4 years and 65.6% of patients were H. pylori positive (CAG 61.5%, DU 90.0%, GU 52.6%, GC 69.2%). Among H. pylori positive patients, group 1 was most common(47.2%), and the next was group 2(41.7%). Group 3 was noted in only 11.1% respectively. There was no correlation between the H. pylori phenotype and various diseases. In H. pylori positive cases, inflammation was significantly increased than H. pylori negative cases(p<0.05). However, there was no significant difference in the degree of PCNA expression between H. pylori positive and negative cases. In cagA positive groups (1 and 2), inflammation was significantly increased than CagA negative group (3 and 4) (p<0.05), but no significant difference between group 1 and 2 was observed 5. There was no significant difference between the degree of PCNA expression and H. pylori phenotype. (p>0.05)
Conclusions
These results suggest that diversity of H. pylori phenoype is correlated with inflammatory degree, but not with proliferating activity in the H. pylori infected gastric mucosa.