AIM:To determine the prevalence of Helicobacter pylori(H.pylon)infection,the serum anti-H,pylori immunoglobulinG(IgG)and IgA antibody responses,and the value of clinicalpresentations in diagnosis of H.pyloriinfection in patientswith gastric atrophy,intestinal metaplasia and dysplasia.METHODS:Ho pyloriinfection was detected by histology in209 patients with mild chronic atrophic gastritis(CAG,n=76),severe CAG(n=22),mild intestinal metaplasia(IM,n=22),severe IM(n=58),or dysplasia(DYS,n=31).Serum anti-H.pylori IgG and IgA were double sampled and evaluatedby enzyme-linked immunoadsordent assays.35 clinicalpresentations were observed and their relationship with H.pyloriinfection was analyzed by the k-means cluster method.RESULTS:Both IgG and IgA levels in H.pylori positivepatients were significantly higher than those negative for H.pylori(P<0.001-0.01).The prevalence of H.pyloriwas highestin severe IM(84.5 %),and lowest in mild CAG(51.3 %)(P<0.01).They were similar in severe CAG(68.2 %),mildIM(72.7 %),and DYS(67.7 %).In H.pylonpositive patients,the IgG levels in severe CAG were significantly higher thanthose in mild CAG(P<0.01).In H.pylorinegative patients,both IgG and IgA levels increased remarkably in severe IM,compared to those in mild IM(P<0.01-0.05).H.pyloriinfectionexhibited no association with patient’s gender(62.1%inmales;71.7%in females)and age(r=0.0814,P=0.241).The diagnostic accuracy based on 35 clinical presentationswas 65.7 %.It could be improved by 5.7%when only theassemblage of digestive symptoms were engaged,or by8.6%when the pathogenic factors,general status andgrossoscopy were combined.The diagnostic accuracy couldbe decreased when only the general symptoms wereengaged,or when the pathogenic factors were accompaniedwith some common digestive symptoms.CONCLUSION:H.pyloriinfection is a major risk factor forthe process from atrophy,IM to DYS of gastric mucosa.Serum IgG and IgA are good indicators to evaluate this progress with a certain arrearage.Investigation on theeffective assemblages of clinical presentations may providea better understanding in the pathogenesis,diagnosis andtreatment for H.pylori infection.
