title: Helicobacter pylori CagA status associated with gastric cancer incidence rate variability in Costa Rican regions.
abstract: BACKGROUND
  We evaluated several risk factors for gastric cancer in Costa Rican regions having contrasting gastric cancer incidence rates, despite the small dimensions of the country.
  
  
  METHODS
  A total of 180 dyspeptic patients were classified into two groups according to the gastric cancer incidence (GCI) rate in their Costa Rican region: group A, with a high GCI rate (n = 91) and group B, with a low GCI rate (n = 89). Helicobacter pylori infection was detected by rapid urease test, Gram staining, and histological observation. Antral and corpus specimens were obtained to assess the grade of inflammation, topography of gastritis, gastric atrophy, and intestinal metaplasia by histological examination. Serum CagA antibody was measured by an antigen-specific enzyme-linked immunosorbent assay.
  
  
  RESULTS
  There was no significant difference in H. pylori prevalence between groups A (73%) and B (63%); however, serum CagA antibody was more frequently detected in group A (79%) than in group B (54%) [P = 0.02; odds ratio (OR), 2.68]. Among patients under 60 years of age, serum CagA antibody was even more frequently detected in group A (81%) than in group B (49%) (P < 0.01; OR, 4.50). The prevalence of corpus-predominant gastritis, atrophic gastritis, and moderate/severe grades of neutrophilic infiltration was higher in serum CagA antibody-positive patients than in CagA antibody-negative patients (P = 0.003, 0.04, and 0.002, respectively).
  
  
  CONCLUSIONS
  Infection with H. pylori possessing the cagA gene is associated with the development of severe gastric damage such as gastric atrophy, leading to gastric cancer, and probably influences the differences in GCI between Costa Rican regions.
authors.affiliation: Department of Tumor Surgery, Kochi Medical School, Kochi University, Kohasu, Oko-cho, Nankoku, 783-8505, Japan.
authors.forename: Sergio A
authors.initials: SA
authors.lastname: Con
authors.forename: Ana L
authors.initials: AL
authors.lastname: Valerín
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Takeuchi
authors.forename: Reinaldo
authors.initials: R
authors.lastname: Con-Wong
authors.forename: Vicky G
authors.initials: VG
authors.lastname: Con-Chin
authors.forename: Gil R
authors.initials: GR
authors.lastname: Con-Chin
authors.forename: Sachiko N
authors.initials: SN
authors.lastname: Yagi-Chaves
authors.forename: Fernando
authors.initials: F
authors.lastname: Mena
authors.forename: Fernando
authors.initials: F
authors.lastname: Brenes Pino
authors.forename: Guillermo
authors.initials: G
authors.lastname: Echandi
authors.forename: Michiya
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Mario
authors.initials: M
authors.lastname: Monge-Izaguirre
authors.forename: Mitsuaki
authors.initials: M
authors.lastname: Nishioka
authors.forename: Norihito
authors.initials: N
authors.lastname: Morimoto
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Sugiura
authors.forename: Keijiro
authors.initials: K
authors.lastname: Araki
mesh_terms: D000328:Adult; D000368:Aged; D000907:Antibodies, Bacterial / Q000097:blood; D000942:Antigens, Bacterial / Q000235:genetics / Q000276:immunology / Q000378:metabolism*; D001426:Bacterial Proteins / Q000235:genetics / Q000276:immunology / Q000378:metabolism*; D003364:Costa Rica / Q000453:epidemiology; D005260:Female; D005756:Gastritis / Q000453:epidemiology*; D005757:Gastritis, Atrophic / Q000453:epidemiology / Q000209:etiology; D016481:Helicobacter Infections / Q000150:complications* / Q000453:epidemiology / Q000382:microbiology; D016480:Helicobacter pylori / Q000235:genetics / Q000378:metabolism / Q000472:pathogenicity*; D006801:Humans; D015994:Incidence; D008297:Male; D008679:Metaplasia; D008875:Middle Aged; D013274:Stomach Neoplasms / Q000453:epidemiology* / Q000209:etiology
chemical_list: D000907:Antibodies, Bacterial; D000942:Antigens, Bacterial; D001426:Bacterial Proteins; C080866:cagA protein, Helicobacter pylori