title: Different gastric mucosa and CagA status of patients in India and Japan infected with Helicobacter pylori.
abstract: OBJECTIVE
  Despite similar incidence of Helicobacter pylori infection, the frequency of gastric cancer is sevenfold higher in Japan than in India. The objective of this work was to define differences in H. pylori-induced gastritis and to identify the bacterial virulence factors involved.
  
  
  METHODS
  We prospectively enrolled 353 consecutive patients who underwent endoscopy and received three gastric biopsies in Tokyo, Japan, and Hyderabad, India. Immunohistochemistry against H. pylori and East Asian CagA and hematoxylin-eosin and Giemsa stain were used to examine gastric mucosal biopsy specimens. Histological scores were assessed in accordance with the updated Sydney System. Subjects with H. pylori infection were matched by age and sex to compare histopathology and bacterial virulence.
  
  
  RESULTS
  Sixty patients infected with H. pylori were prospectively selected. Median histological scores for neutrophil and mononuclear cell infiltration and for atrophy were significantly higher in Japan than in India (neutrophils 4.0 vs 3.0, p < 0.01; mononuclear cells 5.0 vs 4.5, p = 0.03; atrophy 3.0 vs 2.0, p < 0.01, respectively). Scores for H. pylori density and intestinal metaplasia were also higher in Japan, albeit without statistical significance (H. pylori 5.0 vs 3.0, p = 0.08; intestinal metaplasia 0.0 vs 0.0, p = 0.08). Prevalence of East Asian CagA-positive H. pylori was significantly higher in Japan (73.3 vs 0.0 %, p < 0.01).
  
  
  CONCLUSIONS
  The significantly higher prevalence of histologically severe gastritis and East Asian CagA in patients from Japan with H. pylori infection may be involved in the pathogenesis of gastric cancer.
authors.affiliation: Department of Gastroenterology and Hepatology, National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan, fuji.kei.01@gmail.com.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Fujiya
authors.forename: Naoyoshi
authors.initials: N
authors.lastname: Nagata
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Uchida
authors.forename: Masao
authors.initials: M
authors.lastname: Kobayakawa
authors.forename: Naoki
authors.initials: N
authors.lastname: Asayama
authors.forename: Junichi
authors.initials: J
authors.lastname: Akiyama
authors.forename: Takuro
authors.initials: T
authors.lastname: Shimbo
authors.forename: Toru
authors.initials: T
authors.lastname: Igari
authors.forename: Rupa
authors.initials: R
authors.lastname: Banerjee
authors.forename: D
authors.initials: D
authors.lastname: Nageshwar Reddy
authors.forename: Masashi
authors.initials: M
authors.lastname: Mizokami
authors.forename: Naomi
authors.initials: N
authors.lastname: Uemura
mesh_terms: D000328:Adult; D000368:Aged; D000942:Antigens, Bacterial / Q000378:metabolism*; D001426:Bacterial Proteins / Q000378:metabolism*; D015415:Biomarkers / Q000378:metabolism; D001706:Biopsy; D003430:Cross-Sectional Studies; D005260:Female; D005753:Gastric Mucosa / Q000378:metabolism / Q000382:microbiology / Q000473:pathology*; D005757:Gastritis, Atrophic / Q000378:metabolism / Q000382:microbiology / Q000473:pathology*; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000378:metabolism / Q000382:microbiology / Q000473:pathology*; D016480:Helicobacter pylori / Q000276:immunology* / Q000302:isolation & purification; D006801:Humans; D007194:India; D007564:Japan; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D011446:Prospective Studies; D012720:Severity of Illness Index
chemical_list: D000942:Antigens, Bacterial; D001426:Bacterial Proteins; D015415:Biomarkers; C080866:cagA protein, Helicobacter pylori