Helicobacter pylori infection, anti-cagA antibodies and peptic ulcer:: a case-control study in Italy

被引:18
作者
Palli, D
Menegatti, M
Masala, G
Ricci, C
Saieva, C
Holton, J
Gatta, L
Miglioli, M
Vaira, D
机构
[1] Univ Bologna, Dept Internal Med & Gastroenterol, I-40138 Bologna, Italy
[2] CSPO, Epidemiol Unit, Florence, Italy
[3] Univ London, Dept Microbiol, London, England
关键词
D O I
10.1046/j.1365-2036.2002.01253.x
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Aim: To evaluate the association between infection with specific strains of Helicobacter pylori and peptic ulcer in patients referred for upper gastrointestinal endoscopy. Methods: One thousand, Six hundred and twenty-six consecutive dyspeptic patients, referred to one Endoscopy Unit in Bologna, Italy, were enrolled. For each participant, a blood sample was obtained for the measurement of distinct immunoglobulin G antibodies against H. pylori lysate and cytotoxin associated gene A (cagA). A case-control study included the whole series: patients diagnosed with duodenal (n = 275) or gastric (n = 71) ulcer were identified and independently compared with controls with non-ulcer dyspepsia (n = 1280). Results: H. pylori seroprevalence (at least one positive marker) was associated with increasing age, male sex and a diagnosis of peptic ulcer, This association was stronger with duodenal ulcer (multivariate odds ratio (OR), 5.2; 95% confidence interval (CI), 3.5-7.9) than with gastric ulcer (OR, 2.3; 95% CI, 1.2-4.4). Further analyses showed that H, pylori lysate+/caoA- subjects had a moderately increased risk of duodenal (OR, 3.2), but not gastric (OR, 1.1), ulcer. When cagA+ subjects were separately compared with seronegative patients, there was a six-fold increased risk for duodenal ulcer and a three-fold increased risk for gastric ulcer. Conclusions: A strong positive association between infection with a cagA+ H. pylori strain and the presence of peptic disease was found. The seroprevalence of anti-cagA antibodies among patients with non-ulcer dyspepsia is so high (41%) to preclude its use as a pre-endoscopic screening test.
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页码:1015 / 1020
页数:6
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