Relation between Helicobacter pylori cagA Status and Risk of Peptic Ulcer Disease

• Published in: American journal of epidemiology Vol. 155; no. 11; pp. 1054 - 1059
• Main Authors: Nomura, Abraham M. Y., Pérez-Pérez, Guillermo I., Lee, James, Stemmermann, Grant, Blaser, Martin J.
• Format: Journal Article
• Language: English
• Published: Cary, NC Oxford University Press 01.06.2002; Oxford Publishing Limited (England)
• Subjects: Antibodies, Bacterial - blood; Biological and medical sciences; Case-Control Studies; Colonization; confidence interval; duodenal ulcer; Enzyme-Linked Immunosorbent Assay; Gastroenterology. Liver. Pancreas. Abdomen; Hawaii - epidemiology; Helicobacter Infections - complications; Helicobacter Infections - immunology; Helicobacter pylori; Helicobacter pylori - immunology; Humans; IgG; Immunoassays; immunoglobulin G; Immunoglobulin G - blood; Male; Medical sciences; Other diseases. Semiology; peptic ulcer; Peptic Ulcer - epidemiology; Peptic Ulcer - immunology; Peptic Ulcer - microbiology; Probability; Risk; stomach ulcer; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Hawaii; Human; Spirillales; Duodenum; Spirillaceae; Epidemiology; Infection; Helicobacter pylori; Risk factor; Pathogen strain; Bacteriosis; Digestive diseases; Bacteria; Intestinal disease; Ulcer; Anastomotic ulcer; Gastric disease
• ISSN: 0002-9262; 1476-6256; 1476-6256; 0002-9262
• DOI: 10.1093/aje/155.11.1054

Although colonization with any Helicobacter pylori strain is associated with peptic ulcer, it is uncertain whether the risk is greater with cagA+ or cagA− strains, which differ in their biology. A nested case-control study was done, based on a cohort of 5,443 Japanese-American men examined on the Hawaiian island of Oahu from 1967 to 1970. A total of 150 men with gastric ulcer, 65 with duodenal ulcer, and 14 with both diseases were identified. The authors matched the 229 cases with 229 population controls and tested their serum for immunoglobulin G antibodies to H. pylori and immunoglobulin G antibodies to the cagA product of H. pylori using enzyme-linked immunosorbent assays. Persons with H. pylori positivity had an odds ratio of 4.0 (95% confidence interval (CI): 1.9, 8.5) for gastric ulcer and 2.5 (95% CI: 0.8, 7.4) for duodenal ulcer. For CagA positivity, the odds ratios were 1.4 (95% CI: 0.9, 2.4) for gastric ulcer and 2.6 (95% CI: 1.1, 5.8) for duodenal ulcer. Subjects who were seropositive for both H. pylori and CagA had an odds ratio of 4.4 (95% CI: 1.8, 10.5) for gastric ulcer and 5.8 (95% CI: 1.1, 30.0) for duodenal ulcer. The results suggest that colonization with a cag+ H. pylori strain elevates the risk beyond that of a cag− H. pylori strain for both gastric and duodenal ulcers.