Gut 2001;49:341-346 ( September )

Article

The significance of cagA⁺ Helicobacter pylori in reflux oesophagitis V J Warburton-Timms^a, A Charlett^d, R M Valori^b, J S Uff^c, N A Shepherd^c, H Barr^b, C A M McNulty^a

^a Public Health Laboratory, Gloucestershire Royal Hospital, Gloucester, UK, ^b Gloucester Gastroenterology Group, Gloucestershire Royal Hospital, Gloucester, UK, ^c Department of Histopathology, Gloucestershire Royal Hospital, Gloucester, UK, ^d PHLS Statistics Unit, 61 Colindale Avenue, London, UK

Correspondence to: Dr C A M McNulty, Public Health Laboratory, Gloucestershire Royal Hospital, Great Western Road, Gloucester GL1 3NN, UK. jwhiting{at}phls.nhs.uk

Accepted for publication 5 December 2000

BACKGROUNDHelicobacter pylori is a gastroduodenal pathogen associated with ulceration, dyspepsia, and adenocarcinoma. Recent preliminary studies have suggested that H pylori may be protective for oesophageal adenocarcinoma. In addition, strains of H pylori identified by the presence of the cytotoxin associated gene A (cagA) are shown to have a significant inverse association with oesophageal adenocarcinoma. Given that cagA⁺ H pylori may protect against oesophageal carcinoma, these strains may be protective for oesophagitis, a precursor of oesophageal carcinoma.
AIMSThe aim of this study was to investigate the association between cagA⁺ H pylori and endoscopically proved oesophagitis.
PATIENTSThe study group included 1486 patients attending for routine upper gastrointestinal tract endoscopy.
METHODSAt endoscopy the oesophagus was assessed for evidence of reflux disease and graded according to standard protocols. Culture and histology of gastric biopsy specimens determined H pylori status. The prevalence of cagA was identified by an antibody specific ELISA (Viva Diagnostika, Germany).
RESULTSH pylori was present in 663/1485 (45%) patients and in 120/312 (38%) patients with oesophagitis. Anti-CagA antibody was found in 499/640 (78%) H pylori positive patients. Similarly, anti-CagA antibody was found in 422/521 (81%) patients with a normal oesophagus and in 42/60 (70%) with mild, 24/35 (69%) with moderate, and 11/24 (46%) with severe oesophagitis. The risk of severe oesophagitis was significantly decreased for patients infected with cagA⁺ H pylori after correction for confounding variables (odds ratio 0.57, 95% confidence interval 0.41-0.80; p=0.001).
CONCLUSIONSThese results suggest that infection by cagA⁺ H pylori may be protective for oesophageal disease.


Keywords: Helicobacter pylori; cagA⁺; gastro-oesophageal reflux disease; oesophagitis; oesophageal adenocarcinoma; hiatus hernia

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