STOMACH

Host gastric Lewis expression determines the bacterial density of Helicobacter pylori in babA2 genopositive infection

B-S Sheu¹, S-M Sheu², H-B Yang³, A-H Huang³, J-J Wu⁴

¹ Institute of Clinical Medicine, and Department of Internal Medicine, National Cheng Kung University, Medical College, Tainan, Taiwan
² Institute of Basic Medical Sciences, National Cheng Kung University, Medical College, Tainan, Taiwan
³ Department of Pathology, National Cheng Kung University, Medical College, Tainan, Taiwan
⁴ Department of Medical Technology, and Institute of Basic Medical Sciences, National Cheng Kung University, Medical College, Tainan, Taiwan

Correspondence to:
Correspondence to:
Professor J-J Wu, Department of Medical Technology, National Cheng Kung University, Medical College, No 1, University Road, Tainan, Taiwan 701;
jjwu{at}mail.ncku.edu.tw

Background and aims: We tested if host gastric Lewis antigens and the babA2 genotype of Helicobacter pylori correlated with clinicohistological outcome.

Methods: We enrolled 188 dyspeptic patients (45 with duodenal ulcer, 45 with gastric ulcer, and 98 with chronic gastritis) with H pylori infection, proved by culture and gastric histology, reviewed by the updated Sydney system. Gastric expression of Lewis (Le) antigens Le^a, Le^b, Le^x, and Le^y was determined immunochemically to determine intensity (range 0–3). The corresponding 188 H pylori isolates were screened for babA2 genotype by polymerase chain reaction.

Results: All H pylori isolates had a positive babA2 genotype. We identified Le^a in 33.5%, Le^b in 72.9%, Le^x in 86.2%, and Le^y in 97.4% of biopsies from these 188 patients. Patients who expressed Le^b had a higher H pylori density than those who did not express Le^b (p<0.001). Among 139 patients who expressed Le^b, H pylori density increased with a higher Le^b intensity (p<0.05). Gastric atrophy decreased with Le^b intensity and thus resulted in lower H pylori density in the antrum (p<0.05). For the 49 patients without gastric Le^b expression, H pylori density was positively related with Le^x and Le^a expression (p<0.05).

Conclusions: Taiwanese H pylori isolates are 100% babA2 genopositive. Gastric Le^b as well as Le^x intensity may be major determinants of H pylori density. While lacking gastric Le^b expression, Le^x and Le^a were closely related to H pylori colonisation.

Keywords: Helicobacter pylori; babA2; Lewis antigen expression; gastric histology

Abbreviations: Le, Lewis; Lewis-N, total Lewis number; BabA, blood group antigen binding adhesin; babA2, blood group associated binding gene; PCR, polymerase chain reaction; TLI, total gastric Lewis antigen expression intensity; HPD, Helicobacter pylori density; IM, intestinal metaplasia; CIS, chronic inflammatory score; PBS, phosphate buffered saline

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