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Different Gastric Mucosa and CagA Status of Patients in India and Japan Infected with Helicobacter pylori

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Abstracts

Background and Aim

Despite similar incidence of Helicobacter pylori infection, the frequency of gastric cancer is sevenfold higher in Japan than in India. The objective of this work was to define differences in H. pylori-induced gastritis and to identify the bacterial virulence factors involved.

Materials and Methods

We prospectively enrolled 353 consecutive patients who underwent endoscopy and received three gastric biopsies in Tokyo, Japan, and Hyderabad, India. Immunohistochemistry against H. pylori and East Asian CagA and hematoxylin–eosin and Giemsa stain were used to examine gastric mucosal biopsy specimens. Histological scores were assessed in accordance with the updated Sydney System. Subjects with H. pylori infection were matched by age and sex to compare histopathology and bacterial virulence.

Results

Sixty patients infected with H. pylori were prospectively selected. Median histological scores for neutrophil and mononuclear cell infiltration and for atrophy were significantly higher in Japan than in India (neutrophils 4.0 vs 3.0, p < 0.01; mononuclear cells 5.0 vs 4.5, p = 0.03; atrophy 3.0 vs 2.0, p < 0.01, respectively). Scores for H. pylori density and intestinal metaplasia were also higher in Japan, albeit without statistical significance (H. pylori 5.0 vs 3.0, p = 0.08; intestinal metaplasia 0.0 vs 0.0, p = 0.08). Prevalence of East Asian CagA-positive H. pylori was significantly higher in Japan (73.3 vs 0.0 %, p < 0.01).

Conclusion

The significantly higher prevalence of histologically severe gastritis and East Asian CagA in patients from Japan with H. pylori infection may be involved in the pathogenesis of gastric cancer.

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Abbreviations

H. pylori :

Helicobacter pylori

CagA:

Cytotoxin-associated antigen A

NCGM:

National Center for Global Health and Medicine

AIG:

Asian Institute of Gastroenterology

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Acknowledgments

This work was supported by a Grant-in-Aid from the Ministry of Health Labor and Welfare of Japan and a Grant-in-Aid from the Ministry of Education, Culture, Sports, Science, and Technology of Japan (271000) and a grant from the National Center for Global Health and Medicine. The funders were not involved in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We thank Hisae Kawashiro, Clinical Research Coordinator, NCGM, Tokyo, Japan, for assistance with data collection. We express our sincere gratitude to Drs Anuradha Sekaran and Mitnala Sasikala, AIG, Hyderabad, India for the pathological specimens and blood samples.

Conflict of interest

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan

    Keiichi Fujiya, Naoyoshi Nagata, Masao Kobayakawa, Naoki Asayama & Junichi Akiyama

  2. Department of Molecular Pathology, Oita University, 1-1 Hazamacho, Yufu City, Oita, 879-5593, Japan

    Tomohisa Uchida

  3. Department of Clinical Research and Informatics, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan

    Takuro Shimbo

  4. Department of Clinical Pathology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan

    Toru Igari

  5. Department of Gastroenterology, Asian Institute of Gastroenterology, 6-3-661 Somajiguda, Hyderabad, 500082, India

    Rupa Banerjee & D. Nageshwar Reddy

  6. The Research Center for Hepatitis and Immunology, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1 Kohnodai, Ichikawa City, Chiba, 272-8516, Japan

    Masashi Mizokami

  7. Department of Gastroenterology and Hepatology, Kohnodai Hospital, National Center for Global Health and Medicine, 1-7-1 Kohnodai, Ichikawa City, Chiba, 272-8516, Japan

    Naomi Uemura

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  1. Keiichi Fujiya
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  2. Naoyoshi Nagata
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Correspondence to Naoyoshi Nagata.

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Fujiya, K., Nagata, N., Uchida, T. et al. Different Gastric Mucosa and CagA Status of Patients in India and Japan Infected with Helicobacter pylori . Dig Dis Sci 59, 631–637 (2014). https://doi.org/10.1007/s10620-013-2961-x

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  • DOI: https://doi.org/10.1007/s10620-013-2961-x

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